What We’ll Remember About All Those 2012 Democratic Convention Speeches

Now that the 2012 Democratic National Convention has winked into history, a dozen or so memorable moments continue to glow like embers in a late-evening fireplace.

Michelle Obama electrified the faithful with her passion, eloquence and wifely devotion… she could add a good ten years to any man’s life expectancy, especially if that man has been thwacked repeatedly by diehard partisan foes.

Massachusetts senatorial candidate and presumptive Cherokee Elizabeth Warren, an emerging folk-hero for the NPR set, delivered a stirring tribute to scrappy middle-class virtues, along with a persuasive retort to Mitt Romney’s assertion that “corporations are people, my friend.” Warren quoted from her popular campaign t-shirt and posters: “No, Governor Romney, corporations are not people. People have hearts. They have kids. They get jobs. They get sick. They cry, they dance. They live, they love, and they die, and that matters.”

Youthful baldy Cory Booker, Newark’s idealistc, ever-charismatic mayor, galvanized the crowd with his patented Energizer Bunny performance… the guy is a walking, talking electrical power source who could still have a future in national politics.

Highly heralded San Antonio mayor Julian Castro, introduced by his identical twin brother, slipped gracefully into the brilliant-young-minority keynote speaker role perfected by an upstart named Barack Obama back in 2004… though his winsome three-year-old daughter almost stole the show by primping adorably for the cameras.

Prematurely grizzled political fireball Rahm Emanuel — former Obama chief of staff and current Chicago mayor — managed to breeze through his brief tribute to his former boss without uttering a single expletive. Miraculous.

Ditto for the sometimes bumbling, always upbeat VP Joe Biden, who surprised the crowd with a genuinely moving hymn to the U.S. auto industry and its embattled workers (not to mention the president’s role in rescuing them from certain doom). He was at his best when he spoke quietly and convincingly about the importance of the industry to America’s cultural psyche… the kind of intangible value that a pragmatist like Romney would overlook in favor of the accountant’s balance sheet.

Young, articulate and eminently telegenic, the newly minted feminist icon Sandra Fluke castigated Romney and Ryan for their alleged insensitivity to women’s reproductive issues. Noting the deep divide between Democrats and Republicans on abortion, she described “the two profoundly different futures that could await women—and how one of those futures looks like an offensive, obsolete relic of our past.” At least she didn’t call for public funding of late-term abortions.

Former Michigan governor Jennifer Granholm must have been a cheerleader back in high school. Shouting herself hoarse, arms waving wildly to and fro, she tallied the number of jobs saved by the Obama administration in half a dozen states, culminating with (of course) Michigan. (“211,000 good-paying, AMERICAN jobs!,” she yelled triumphantly.) Loud enough to make the average TV viewer adjust the volume, she scored a solid extra-base hit with her fellow Dems in the convention hall.

Instead of geriatric cowboy-director Clint Eastwood, who inadvertently delivered the most memorable remarks of last month’s GOP convention, the Dems mounted an eye-appealing parade of show-biz celebrities-du-jour and recent celebrities-du-jour, none of whom added much of substance to the proceedings. The Democrats seem to relish their role as the party of choice for Hollywood’s pretty faces.

Former President Bill Clinton lent his own superstar lustre to the convention. The aging Arkansas Fox, weighing midway between trim and anorexic (he’s gone vegan since his two close encounters with coronary disaster), blasted it out of the bleachers and then some; his 48-minute oration in praise of Obama garnered the highest plaudits of the convention from pundits and politicians alike.

First he disarmed the opposition by praising virtually every Republican president since Eisenhower, but he contrasted those honorable gentlemen with today’s obstinately partisan GOP. Blasting the “right-wing factions that have taken over the party,” he shredded Romney & Co. by cleverly reframing the reasoning behind their pursuit of Obama: “We left him a total mess [in 2008], he hasn’t cleaned it up fast enough, so fire him and put us back in.” He astutely characterized the president as “a man who’s cool on the outside but who burns for America on the inside.”

As with any vintage Clinton speech, his Charlotte barnburner managed to fuse passion, policy and plain old common sense into a clear and compelling message. But this one had something extra: a righteous defense of the basic Democratic (as well as small-d democratic) ideals currently under assault by conservative ideologues. CNN anchor Wolf Blitzer immediately canonized the speech as the greatest of Clinton’s career, and other talking heads quickly followed suit.

I was simply relieved that Clinton didn’t keel over at the lectern, but I had to agree that the speech was a personal and political triumph. Unfortunately, the ex-president raised the bar impossibly high for the current president, essentially playing the hot-blooded Captain Kirk to Obama’s cerebral Mr. Spock.

Spock delivered, though. Barack Obama deliberately shed the mythic poetry of his previous convention speeches in favor of a more sober and presidential address that reflected his hard years at the helm.

Looking fit and confident, Obama managed to hit most of the right notes for a liberal leader who governs from the center: America’s traditional belief (and a true moderate’s article of faith) that “everyone plays by the same rules”… the peculiar Republican zeal for cutting taxes on the rich and easing regulations on Wall Street while gutting government benefits for the middle class and poor (“we’re not going back there,” he assured us)… a much-needed plan to restore the proud “Made in America” brand by rewarding companies that create jobs here in the U.S. … the vital importance of affordable education and health care (repeat: affordable, not free) … a warning about letting our government fall into the hands of big lobbyists “with checks”… and a pledge to use the money we’re no longer spending on wars to “do some nation-building right here at home.”

Obama has been known to break promises he made in the heat and idealism of his 2008 campaign, so he scaled down the level of commitments this time around. He sidestepped policy-wonk specifics in favor of big-picture goals and ideals. (Nothing wrong with that: this wasn’t the State of the Union Address, after all.) He confessed his disappointments and took the high road, refraining from blasting the obstructionist tactics of the GOP opposition in Congress.

The president spoke persuasively of the need for balance between entrepreneurship and responsible citizenship… for replacing the “What’s in it for me?” mentality with “What can we do together?” Collectivism? No… just an overdue recognition of the fact that — guess what? — we all play for the same team. Class warfare? No again… Obama was adamant that success in America is something earned rather than given freely. A call for big government? Guess again: Obama insisted, with admirable moderation, that government can’t fix everything but it’s not the problem. “Not every problem can be remedied with another government program or dictate from Washington,” he said. Nobody but a hidebound libertarian could call his vision socialistic.

The New Moderate hopes Obama can muster enough political clout and savvy to convert his vision into a model of inspired centrist leadership. He’ll have to shun the constant nattering of special interests on the right and left, but if anyone other than Bill Clinton can do it, Obama can.

Would the auto industry bailouts be an example of playing by the same rules ?

I would point out that almost the entire progressive social safety net is premised on different rules.

All of us are obligated to pay social security and medicare taxes, but a few of us are not obligated to live off social security or depend entirely on medicare for healthcare. Most of the investments available to the wealthy are not available to the rest of us.

None of this is because the wealthy chose to preclude us from their domain, but because government has decided that unless you are extremely wealthy, you are too stupid to be allowed to make a wide variety of different investments.

Just returned from spending a week at the beach with family that included 3 children (plus spouses for 6 total) in their late 20’s and two infant grandkids. Was interesting to listen to all talk about the election and the positions of the parties. Since all are very conservative fiscally and liberal socially, they are torn between voting for one party or the other. They see a country going into the economic gutter when their kids get in college (or even before) due to the high debt and deficit if the democrats control things, while they see the republicans trying to control individual rights by reversing Roe v Wade, gay marriage, etc. It was a perfect picture of how the parties do not represent the majority any longer, but are controlled by the wings of each partiy, leaving the moderate majority of Americans with a really bad choice.

The one positive issue all talked about was Romney’s flip flop positions. They know to gain the nomination, one has to run on the far fringes of the parties positions while trying to gain the nomination, then they can move to govern from their personal positions once in office. They see Romney as one that will govern from the middle, much like Clinton, and work with congress to get something done instead of divide and conquer as followed by the current administration.

The most important issue after the economy in this election is the surpreme court nominations that will be presented by the next president. Most likely 2, if not 3 nominations will be made and that will set the course for a liberal or conservative period of legislation for 20+ years. If the current environment continues after November, what you saw with the current congress will look like hyper activity compared to what will happen when Obama begins sending SCOTUS nominations and budget legislation to congress.

Ron P;
Romney and the GOP have made it abundantly clear there is only one thing on their agenda – the economy.
Ronald Reagan and every Republican candidate since ran on the same social conservative planks as Romney. Rowe has not only survived by thrived. There is no issue Ryan or Romney would prefer to talk about less than abortion. Like it or not both parties have reached MAD – mutually assured destruction on that issue. Nothing will assure a republican victory in subsequent elections than democrats substantially liberalizing the status quo. Nothing will ensure democratic victory more than republicans substantially disturbing the status quo. Pretending that something has changed significantly is the pinnacle of hypocracy.
The vast majority of us grasp this is the great non-issue of this campaign.

Romney’s flip flops are fair game. But Obama has flip flopped atleast as dramatically. The GOP is unlikely to take much advantage of that – because on those issues where the president has flip flopped – the war, guantanamo, torture, immigration, the patriot act executive priviledge, exective power, he has flipped to substantial agreement with the GOP.

The supreme court is indeed important – though most people are ignorant of its importance. At the same time why are we to expect either of these two to substantially alter the status quo. Or even nominate a competent justice who has actually read the constitution ?

Last year the court had 14 5-4 decisions – the results in 8 were conservative coalitions, 6 were liberal. Contrary to the rhetoric, this court has been rather tame.

It is extremely unlikely that new entries to the court from either party are going to side with individuals over government on pretty much any issue.

asmith..yes the GOP has maintained it’s position on social issues for many years, but the point I was making is the issues with the younger voters trying to decide if fiscal issues are more important or if social issues are more important. Today there is about 46% of so that will vote democrat regardless. There is about 42% that will vote republican regardless. (These percentages may be off a couple due to various sources these numbers come from). That leave about 10-12% that can be convinced to vote either way. For those over 50, many will choose fiscal matters. For those under 40, most will choose social issues. The 40-50 are in transition and split about 50-50 either way.

In order for the GOP to win 50.1% of the vote, they have to convince a larger percentage of the population to support them than the democrats. Since the younger voters are more inclined to worry about the impact of policies on them personally like abortion, contraception and gay and lesbian rights, that means the pool for the GOP to sway is much smaller and a harder uphill battle. They have to take the 40+ age groups by an overwhelming percentage to get to 50.1%.

And each year the demographics are working against the GOP as the country is getting darker and getting younger in many of the swing states like Virginia and North Carolina. If this were 10 years earlier, there would be no question North carolina would vote for Romney given the overwhelming vote on the gay marriage amendment, but today due to the changing age and racial makeup, North Carolina is a virtual tie.

If social issues remain the same in the GOP platform as they are today, the GOP will be a dying party on the Presidential level. Romney may be moderate, but party platforms are driving some to the other side.

You’re Late Rick! I was beginning to worry about you. Boy, are you gonna hear it for this one, heh.

I’ve been saving this excerpt from the David Brooks on the DNC:

“President Obama offered other small and worthy ideas, familiar to him since his days in the Senate, that would make America better — more long-lasting batteries, more trade agreements. But these are improvements fit for countries that are already firmly on the right track.

The country that exists is not on the right track. It has a completely dysfunctional political system. What was there in this speech that will make us think the next few years will be any different? America will only be governable again if there is a leader who breaks the mold and reframes the debate. Romney is unlikely to do that, and Obama’s speech didn’t offer much either.”

Its that ungovernable part that strikes a chord with me. 80% of us ARE governable, the 20% who are not have brought the USA to a dreadful position, along with the media who cater to them. The people who get elected to the House and Senate represent the 20% of Americans who are two standard deviations from the center. Strangely, thus far, there seems to be no known way to overcome this, moderates, rational conservatives and rational liberals who are one standard deviation out from the center have little or no clout in choosing congresspersons and thus in the direction of legislation.

The moderate revolution has not materialized, moderates vote and settle presidential elections, but other than that are invisible in the process and demand very little. I wish I knew how to change that.

I would be happy to agree with both you and brooks that the President brought small ideas and a small voice to circumstances that demand much more. I will be happy to agree that Romney is likely to be much of the same.

But this myth that twenty percent of us run the show just demonstrates how out of touch you are.

It is irrelevant whether 20 or 80% of us are governable. It is not the unruly nature or the american people that is our problem – that has always bee one of our greatest assets.

The problems we face are failures of government. The fact that so few here at TNM are willing to admit that the flagship progressive programs are failing and threaten to drag the nation down with them, show how unmoderate TNM is.

You can beleive against evidence that “the great recession” is a reflection of business rather than government failure. I am not sure how you can blame Bush without blaming government. But how is it that the failure of social security, medicare, our suffocating debt, are problems rooted anywhere but government ? You can whine that you do not like Republican plans to fix the problem, but you seem to want to pretend there is no problem, or atleast that we can solve government failures totally nearly a trillion dollars a year with little or no pain to anyone. It is precisely that kind of self delusion – on the part of both parties that got us into this. What Republicans have offered is insufficient, and painful, but democrats are offering nothing but wistful thinking.

Elections are decided by those in the middle – but I have not seen the middle at TNM.

“We can start with term limits and the end of the professional politician. I see NO value add in the current system of lifetime jobs and pensions. They can hardly lay claim that this system works.”

The small sliver of reality that you and I agree on, jbastiat, has been found. In fact I believe that every long term participant in this blog, and a large majority of Americans agree on this. Unfortunately, the Supreme court and Constitution seems to stand square in the way of it.

I’d like to believe that there is some way Americans could do this without passing any laws, just by changing their behavior, but then I would also like to believe that Americans would change their behaviors and buy American goods over Chinese ones voluntarily, without any laws or tarrifs ( this is a tangent, Please, please do not try to connect these ideas in any way other than that they are two things I wish Americans would change without any legislation by changing their behaviors, but, sadly, they don’t and they aren’t about to either).

The Supreme Court and the constitution are no more an impediment than they were intended to be. It is proper that serious changes to the structure and limits of government are well thought our – even tried at the state level before being implimented nationally.
I think a number of measures that have sufficient public support such as term limits and balanced budget requirements meet that standard.

I wish that we had given other limits within the constitution more respect before williy nilly ignoring them and then pushing the supreme court to rewrite the constitution to accomidate our whim.

The constitution is intended to be a living document – but substantial changes in meaning were meant to be accomplished by amendment and that was intended to be a difficult process.

If term limits are to be effective, they can not be repealed by the next congress. That kind of permanence requires ammendmending the constitution.

As a by the way, I was in mostly agreement with AMAC when he described how and why he will vote and how the POTUS, House and Senate should be divided after the election in a fair and just world, House Democrat, Senate narrowly, GOP, and Romney. I would be happy to vote for Romney (well, without Ryan) IF I knew that the Democrats would have very narrow majorities in congress.

As of today, the House will be in Republican hands with almost no numerical change, the Senate is a tossup but seems to be headed for a slight GOP edge, and Obama got a large bounce from the DNC and its his race to lose, with a much clear electoral college path, as long as Ohio goes his way, which it seems it is.

In my opinion, the issue that will actually settle the POTUS issue is Iran. Most Americans do not want another war, they are exhausted. That does not favor Romney. Obama has kept us out of new expensive bloody military entanglements.

To this point Obama’s post convention bounce is about 1/2 Romney’s but it takes several days to fully assess that. At this moment Obama is still rising and Romney falling, but they are still inside the margin of error.
The long term trend is in the opposite direction. August jobs numbers are in and they are abysmal. There is not likely to be any good news of consequence between now and the election. Democrats are largely unmotivated. Turnout among democratic constituencies will be key. Bush managed to pull off a bring out the base election against the odds in 2004, Obama is attempting the same thing, but I think the odds are longer. There is a long time before the election.

My view into the crystal ball sees the GOP controlling government in 2013 much as democrats did in 2009 – and that is precisely what concerns me. The GOP is not yet ready to lead, they have not really learned the lessons of 2008. They do not fully understand that Government is the problem. So long as anything – such as defense spending cuts are not on the table, they are not ready.

Fascinating, absolutely fascinating, a mind that will not, cannot, accept hard facts that are not consistent with what it wants to believe and simply invents its own reality.

Dave, as of yesterday Reuters, Gallup and Rasmussen polls all gave Obama a 5 point lead and CNN gave him a 6 point lead, with 52% of the vote. Nate Silver placed an Obama victory at 4-1 odds, with Obama leading in 8 of 9 swing states. But all you need to do to appease your cognitive dissonance problem is post some more of your gigantic store of fictitious nonsense: “Obama’s post convention bounce is about 1/2 Romney’s” and say it in your usual steady, certain, “I’m just a rational objective man who is debunking wild liberal claims” voice as if it were handed down on a tablet from God. Gallup gave Romney a 0 point post convention bounce, Obama is up to five at Gallup. The total at RCP of polls seemed to give Romney a 1-2 point bounce. Honest pollsters state that the Obama bounce may simply fade away, partisan GOP pollsters state as a fact that it will fade.

Like the idea that it is generally agreed that Britain has the worst health care system in the world or that we would be better of with 1/5 the government we have now, your basic product is simply delusional, even though you appear to be hyper analytical, its a facade. Your basic views are those of a “crazy” with “no credibility”, as jbastiat wrote.

The world of political thought and philosophy is one in which everyone deludes themself, everyone, including definitely me. But the scale on which you do it is truly fascinating.

Gosh, Rick–it’s your blog, so I guess you set the rules about what constitutes moderate commentary. It certainly must not involve any sense of neutrality. Your analysis of the re cent DNC emotionorama could not have been more giddily pro-dem if you were a twelve year old school girl with ZERO experience of the real world, and no ability to recognize blatant marketing pap aimed at a target group (women). How did the revered author of The Cynic’s Dictionary turn into an unabashed fan of the party of absurdity?

RP: I still insist that today’s Dems are more centrist than today’s GOP and even the relatively moderate (by current GOP standards) Romney. Sure, there’s a shrill faction of sandal-clad lefties that clamors for free goodies and favoritism toward special-interest groups… but they’re in the minority and Obama isn’t one of them. Aside from Sandra Fluke, they weren’t much in evidence at the convention. Heck, they couldn’t even push their deletion of God and Jerusalem past Obama; he insisted on inserting them both back into the platform.

You think it’s schoolgirlish to fall for the Democrats’ pieties? Well, I’m beginning to think that supporting the right is a badge of misguided macho street cred. Arm the alpha males of Wall Street and corporate America with extra ammo to screw the middle class!… let poor people lie in their own filth… put a semi-automatic in every home!… pour a few trillion more into the military and bomb Iran back to the Stone Age… bring on the melting icecaps! Hell… we’re men and we can take it.

No thanks, I’m afraid I’ll have to side with the schoolgirls in this election.

Rich: Are you telling me that the middle class hasn’t been screwed royally during the past 10 or 12 years? Downsizing, outsourcing, long-term unemployment, qualified people over the age of 45 who can’t BUY a job… young college grads who will spend their prime years paying off debts instead of buying a home… decreasing income… zero interest on savings accounts coupled with up to 30% interest on credit card accounts… bank fees up the wazoo, nickel and diming us to death. Hey, this is depressing… I could use a good pub crawl!

The so-called middle class (remember people move in and out of the category the time) has had its share of issues. That said, it has ALWAYS had its share of issues. I doubt there are folks sitting around saying: :hey, let’s screw the middle class.

Time marches on and if you were middle class and had a job putting on fenders at a GM plant, you cannot do that anymore. The world we live in is move up or move out. I didn’t create that nor did you. It has ALWAYS been that way. Global trade has pushed up the pace but candidly, government has probably been at the forefront of this squeeze. Everytime the government mandates a cost on to employment, it makes employment less attractive as an investment.

It IS true that the middle class is getting squeezed. It is NOT true that they are shouldering the burden of taxation. It is also true that no government will “help:” the middle class. That is up to each individual.

Rick I would suggest that government has little impact on the economy other than its effect through regulations and he feds monitary policy. You stated the following over the past 10 years impacted the middle class.
Downsizing…Every economy goes through periods of economic change. If it were not for the unions in our auto industry, we may have seen more downsizing as technology can replace many industrial workers. Example,European car companies where the greatest percentage of the car is produced by robots.
Outsourcing..When you can find labor overseas that is less expensive and can provide a product that is acceptible to the public, most any industry is going to outsource. People can continue to cry in their milk over breakfast because they are having a hard time getting a job, but then they go to Walmart and buy cheap Chiness junk or electronics made in Korea or Japan and wonder why they can not get a job.
Long Term Unemployment… people over 45 not being able to buy a job…A product of the above two items as well as not having skills to fit into the higher technology fields required today.
Young college grads paying off debts and not buying a home…Product of government policies that promote student loans to kids that can not afford the loan for the university they attend. When colleges have 100 openings and 500 applications when only 200 can afford to attend the school without a loan, it drives up cost because the demand exceeds the openings and colleges can drive up their cost. If only a few more applied than the number of openings, then they could not drive up costs as high as they are.
0% interest on savings coupled with 30% credit card debt….There are investments one can make that provide a much higher return on savings. They just need to take the time to find where investments as low as $500.00 will provide a greater return. for instance, most any investment in a utlity stock will give 4-5% return. As for 30% credit card debt, if you are dumb enough to run up credit card biolls for flat screen TV’s, fancy mobile divices and other toys that are not a need but a want, then let them pay 30%. Save the money and then buy it for cash and avoid the 30% like people did that were not part of the generation raise on debt.
Bank fees..Get a credit union account or community bank account and avoid those cost. It ain’t hard.
The past economic decline was due mostly to government policies that began in the late 80’s or early 90’s and continued until today. Had banks been restricted to state or regional status like they were and had they not been allowed to merge banking actions with investment firms, the past decline would not have happened. And both of these changes were bi-oartisan decisions, not left or right, just stupid.

Rick, you are spot on about what has happened to the middle class in recent years. As you know, I have been a strong advocate for a strengthened social safety net in America and have been demoralized to see how, instead, the safety net has gotten thinner (while, the whole time, hearing about the secure and wonderful atmosphere my cousins’ children in Denmark are growing up in). But, as of late, I have come to feel that the future in America is not as dire as I had imagined. If Obama wins, the social safety net will be strengthened. If the Republicans win, they will continue to institute policies and encourage practices that will ultimately pare the ranks of the middle class and increase the ranks of the poor. Eventually, the vote of the American poor will overtake, and finally, conscience will return to America.

I will be happy to tell you that the middle class is better off today that 12 years ago. What they are not is better off today than 5-6 years ago
conversely return to 3.5% growth and they will rapidly be better off than 5-6 years ago.

The middle class is worried about the current crisis, but they are not the hardest hit – both the rich and the poor have been hit far harder.
The largest gains in unemployment are with the poor – this is always true in a recession. The middle class moves a percent or two at the most. The poor take the big hit in employment. The rich in contrast take the biggest hit in income. Tax revenue has been way down – because most of our taxes are paid by the rich and their incomes are down as much as 30%. The middle class has seen no drop in wages. Further both the right and left have fallen over each other passing middle class tax cuts – which are the absolutely stupidest way to cut taxes possible. the Bush tax cuts were not as “stimulative” as anticipated because a substantial portion were middle class cuts. The “stimulus” was not stimulative for exactly the same reason.

Do not get me wrong – I greatly appreciate and will take advantage of every penny I can get from government. But if you want to repair the economy – cutting taxes for the middle class has a net negative benefit.

More people go to college today than ever before. I am deeply concerned that government education loans are creating a college bubble much like the housing bubble with potentially disasterous results. But government has no ability to reduce the price of anything. If you want education prices to come down – get the government out of the college loan business. college prices have risen by almost exactly the amount students are able to borrow from the government. The terrible burden of debt you complain about is just a government sanctioned wealth transfer from students to colleges. All that is necescary to correct it, is for students to not be disconnected from the cost of their education. We are making precisely the same mistake with college education we have made with medicare.
This idiotic belief that if you divorce people from the cost of something that they will not consume more and that the price will not go up.

Downsizing and outsourcing are eternal – get used to it. You do know what a Luddite is ? Why is it idiotic to rant against the spinning loom but not against modern means of improving efficiency.

The reason that our wealth has increased dramatically over the past 3 decades is that the real cost of most everything has declined.
it declines because we are more productive. Being more productive means it takes fewer people, or cheaper people to do the same job. If you want this to end – learn to live with the 0% growth we had for the first 150,000 of human existance – it is pretty abysmal.

Why do you expect interest on your saving account when mortgages are going for 3% and the fed is loaning money at 0% ?

Absent the Federal reserve you would see moderate deflation – that is supposed to be horrible, yet the 150 years we experienced that had the highest average growth in our history, and the greatest increase in standard of living.

You can thank Dodd-Frank for new bank fees and credit card interest rates. The effects are pretty much precisely what was predicted. Why is it that you keep believing that government intervention ever makes anything actually cheaper ? At its very best government can just transfer the cost for poor to rich, from old to young, while increasing it along the way.

What I find most head bangingly idiotic is that real economists have been trying to tell us for decades, there is no free lunch. That all government actions have cost. That the cost MUST nearly always be higher than the benefit. Frequently such as Dodd-Frank they predict precisely the effects.

Yet somehow government escapes the blame for the consequences of its actions.

Insanity: doing the same thing over and over again and expecting different results.
Albert Einstein

I am praying that we rush headlong off the real fiscal cliff – not this fake one in January, because I can not see anyway that most TNM’rs will grasp that you can not spend what you do not produce until they have cracked their skulls open trying to prove that wrong.

The only good news is that with good behavior economic skulls actually heal extremely fast – contrary to the view of politicians.

@jbastiat…The funding just isn’t there to serve people in need. I live in Southern California, and I have seen people here who qualify for Section 8 housing, for example, but who cannot receive benefits because there just isn’t enough money allocated to Section 8 funding. So, what happens is a kind of triage, where homeless working families with children are helped but not, say, an unemployed person who has used up his/her savings and has no choice but to live on the street. Take health care, also…you could be penniless, but if you don’t fit specific criteria (have a disability, are in a family with children, are pregnant, are elderly), you cannot receive Medicaid…that means you just can’t get healthcare unless it’s an emergency situation. There are county programs for low-income people with chronic medical problems, but without a chronic health problem, you are out of luck there, too. I’m just amazed at how people can fall through the safety net if they don’t fit the specific criteria. Even food stamps carry an unrealistic income level…a single person can have no more than about $900 in net monthly income to qualify. This idea that being very poor enables one to get government assistance just isn’t accurate. That’s why so many people in California cities live on the street. And, it’s so counterproductive. In San Diego, for instance, one downtown hospital is a revolving door for street people suffering one medical crisis after another related to their homelessness. I’ll tell you, my relatives in Denmark are shocked by the lack of help America gives its people in need. I’m sure they are quietly thankful that their grandparents or parents were not in the half of the family that came to America.

So, you are you saying that SoCal does not tax its citizens sufficently? If so, what tax rate would you have them pay to improve the “safety net?” Or, alternately, what expenditure would you cut to improve the SN?

All programs have conditions in order to qualify for aid. Are you suggesting an alternative?

@jbastiat…I do think Californians–especially well-healed Californians–should pay more in taxes. I agree with Warren Buffet the Prop 13 (CA’s landmark property-tax initiative) should be reversed. It’s amazing how little property tax is paid, relatively speaking, by owners of some of the multi-million-dollar homes near the shore. As an aside, I find it appalling that California pays more in federal taxes than it receives back while almost all red states get back more than they put in…AND the red states gladly take this continual windfall, while the whole time insisting that they want little government and low taxes. Blue-state secession…now, that’s an idea whose time has come.

@jbastiat…Perhaps you were subject to Mello-Roos? You got me curious, so I decided to find two comparable houses in the two places I know very well (San Diego and Long Island). It took a little doing to compare apples to apples, but I think I found two very comparable houses. I chose two communities (Poway, CA, and Massapequa, NY) that are similar: both have middle class with some upper-middle-class, and both have sought-after schools, but not extremely sought-after schools. I needed to find older houses to avoid Mello-Roos in CA. So, these are the houses I found for sale: Massapequa house was built in 1965, 1/4 acre, 4 bed, 2 bath, asking price of $305K. Poway house was built in 1961, 1/5 acre, 3 bed, 3 bath, asking price of $299K. These look to be very similar houses/properties. The current property tax of the Massapequa house is $8,531. The current property tax on the Poway house is $3,528. This difference was typical of what I saw between the NY metro area and the San Diego metro area, whether comparing middle-class or upper-middle-class property taxes. With respect to undocumented people, most of them rent rather than own, and part of the rent one pays does go to property tax, via the landlord. As far as income tax, I don’t really know. I have read that some undocumented workers have Social Security numbers and their employer withholds some funds from their pay.. But, I would imagine they account for a small percentage of undocumented workers, and it probably is the reality that most do not pay income tax. It is also reality that politicians on both sides of the aisle seem to have a vested interest in keeping the broken immigration policy in place. I really have a problem with the hypocrisy of it.

So, you pick the great NYC area to compare to SD? Hmm. To my knowledge, the greater NYC area has one of the highest RE tax burdens in the country. Sorry, I don’t think this is a valid comparison but kind of inadverdent cherry picking.

My RE taxes in Iowa are MUCH lower than in SD and I can tell you, the services and schools are far superior than what I was receiving. Our students actually have school buildings and not trailers.

@jbastiat…I’m sure you are right that many places in the US pay lower property taxes. I just chose the two places I really know. But, places with much lower property tax also tend to have much lower real estate prices. And, if you can afford to pay a lot for a house, I say you can also pay a higher amount in property taxes. With respect to quality of schools, I don’t know what district you lived in, in California, but school districts vary so greatly in many states that it’s really impossible to make a blanket statement. We came 3,000 miles for the CA school district we moved into and couldn’t have been happier. That’s not to say that our school districts in NY and CT weren’t fine, but they just weren’t as good a fit for us as the one in CA. Of course, I know that there are school districts in CA that don’t measure up, at least by measures I would make, but really, there are many different opinions on what constitutes a good school district.

And if you heard the actual voice vote on the Platform changes they could not even manage God and Jerusalem.

This is the party you think is more in touch ?

Pres. Obama is not your typical Scandal clad lunatic lefty. That does not make him moderate. Pres. Obama’s actions as president are FAR to the Left of Pres. Clinton’s regardless of political speeches.

Sorry despite the ad hominem, the current GOP is far closer to moderate than the current Democratic party. Democrats do not even know what they stand for – well except that it is against the GOP. They have no real plan no vision. They are still pretending there is no real problem everything will be ok if we just drink more of the cool aide – or maybe it is more of the hair of the dog that bit us.

“Poor people lying in their own filth. Sure, with their cell phone, tatoos, and cigarettes.”

If we are going to deal in caricatures, for comic relief here is another example of the same type of rhetoric on the poor. Well, the culprit is Australian, but she is also the richest woman in the world and she is talking that talk that fiscal conservatives seem to admire and she does sound a bit like jbastiat. Missing is the her picture, she’s more like a beached whale than a wealthy heiress. For the record, I don’t think many US republicans go so far in their naked articulation of greed.

“The world’s richest woman, Australian mining tycoon Gina Rinehart, drew international scorn recently after saying that people who are jealous of the wealthy should drink less and work harder.

And now she’s back with some more helpful advice.

Speaking at the Sydney Mining Club, Rinehart said her country’s mining industry couldn’t compete with nations that are willing to pay workers less than $2 a day for their sweat and labor.

The implicit suggestion: Employers should be free to pay workers whatever they please.

This echoes Rinehart’s earlier to-do list, in which she urged Aussie lawmakers to cut the minimum wage so that, well, she wouldn’t have to spend so much money on things like workers’ salaries and benefits.

“The evidence is inarguable that Australia is becoming too expensive and too uncompetitive to do export-oriented business,” Rinehart said at the Sydney Mining Club. “Africans want to work, and its workers are willing to work for less than $2 per day. Such statistics make me worry for this country’s future.”

Yep, it’s getting harder and harder to be a job creator.

Rinehart knows what it means to pull yourself up by the bootstraps. She inherited a fortune now estimated to be worth about $18 billion. That’s a heavy burden to bear.

Yet, inexplicably, Australian Prime Minister Julia Gillard didn’t take Rinehart’s advice in the generous spirit with which it was offered.

“It’s not the Australian way to toss people $2, to toss them a gold coin, and then ask them to work for a day,” Gillard said. “We support proper Australian wages and decent working conditions.”

Socialist.

As Rinehart observed in an earlier magazine piece: “There is no monopoly on becoming a millionaire. If you’re jealous of those with more money don’t just sit there and complain, do something to make more money yourself. Spend less time drinking, smoking and socializing and more time working.”

And, apparently, you should be happy with whatever table scraps you receive by way of compensation.”

You left out lottery tickets, junk food, porn and video games. And what you have described IS filth; the other kind of more filthy filth, aka dirty and rancid living conditions also exists in plenty in both rural and urban poverty and I have seen both.

Please find a single credible economist that actually beleives in minimum wage laws. The few fraudulent studies that claimed that they were not a total disaster have been well debunked.

All a minimum wage law does is set the minimum an employee must be able to produce in order to get hired. If an employer does not beleive you can produce that much – they will not hire you. Do you not understand why, unemployment is highest among poor uneducated minorities – it is solely because no sane businessman is willing to risk that they can produce enough to pay them the minimum wage.

All minimum wage laws have ever done is to increase unemployment.
They drive automation – machine do not require minimum wage.
The drive outsourcing – nor do workers in other countries.
They do not increase wages anywhere more than temporarily.

They prevent those at the bottom from ever developing the skills or track record necescary to get a better job. The only successful Job training program ever has been a real job.

When you rant this crap about minimum wages you are condemning poor minorities to permanent poverty. You rant about Rinehart – atleast she is prepared to offer alot of people a job – at the price that she can make work.

If you are so gung ho on the minimum wage – start your own business and pay whatever you wish. Until you do so quit pissing over people who are freely offering others money for work.

Eliminating the minimum wage does not force anyone to work for less.
Are you making minimum wage right now ? If not why not ? Why does any employer pay anyone more than the minimum wage ? What forces them too ?

Wages are set by the market not by companies. You get paid what you are paid because that is how much a company must pay to gain the contribution to production that your skills provides. If you could get significantly more – most of us would. If companies could pay you significantly less they would. For the overwhelming majority of us no law sets our wages. We are paid based on our worth.

Ms. Rinehart will pay the least that she can, and those working for her will seek the most they can. The actual wage that the market will settle on will inevitably bee the one that allows ms. Rinehart to make a profit – because if she can not everyone loses their job, but not too much profit – either wise employees will demand more or competitors will come in and take away her market.

What exactly is evil about offering someone a job ? Is it better for the poor to remain in poverty on the dole, or to take a crappy low paying job that offers the possibility of proving one is worth more, and getting a better one in the future.

The only party holding a gun to anyone’s head in this is the government.
It is government saying to the poor – you may not work for less.
And government saying to business, if you can not afford to pay more than you can not hire this person.

Why is any free trade of work for pay between two consenting people ever illegal ?

You rant about exploitation but it is you that seeks to deprive people of jobs. You are seeking to impose rules that other people have to live by. You are telling millions of people – you are not good enough to have a job.

As to who is to blame that the middle class and the lower quintiles are getting squeezed or screwed, all the real culprits are huge impersonal forces that are not generated by individual people or corporations or government. The Dems prefer to hate some of these forces and defend others and the GOP is their mirror image. Both parties have their heads in the sand and cannot solve any but the most immediate problems, those that will occur in the next few months.

When we get a moderate government someday, by which I mean a congress that is mostly composed of reasonable people who are not ideologically blinded by one of the two competing fairy tales, then perhaps we can understand and try to cope with those forces, international competition that is increasingly a race to the bottom, illegal immigration, a changing energy supply, climate change…

There is no rule that the story has to have a happy ending, and I suspect that it does not.

One of your fans asked why give Obama 4 more years to divide the country. A perfect example of cult Republican!! Was it not some leaders of the Republican Party meeting in Dec. 08 to decide how they could block this new President at every turn. If he failed they would be back in power. This party does not care about this country….just power. After the disastrous Bush years and the results of their fiscal irresponsibility why should anyone trust them to “fix” anything?

Anonymous, there is a reason why an opposition party exists, and it is to defend and represent the +/- 50% of the population that put them in office. Obama vowed to “fundamentally trransform” our nation into somethng different than it has been. The GOP rightly has tried to block that fundamental transformation at every turn.
That is not divisive, that is what two party government is about. Just as the Democrats often tried to block Bush….except that Bush, like Clinton before him, was willing to work with the oppostion on many issues (Medicare, Amnesty, etc). Nevertheless, the Democrats proudly called themselves “the party of no” until Obama took office, after which time that appellation became a pejorative used against the Republicans.

Comedian Lewis Black, a Democrat (albeit an iconoclastic one), once said something to the effect that the “Republicans are the party of bad ideas and the Democrats are the party of no ideas”……I don’t usually agree with wise-ass liberal comedians, but in this case, Black strikes dangerously close to the truth. Democrats have done nothing to solve our economic woes – the stimulus was a gigantic waste of money, used primarily as a slush fund to pay off their voting blocs and big donors. I don’t consider all of the Republicans’ ideas bad – but I certainly don’t agree that the Republican take is always the best. The fact is, however, that the GOP has at least made the attempt to address the core problems of the deficit and the national debt. And Romney made clear in his acceptance speech that he considers bipartisan reform his priority. For those reasons, I think it’s time to give the GOP its chance at bat. The Democrats have struck out.

One of the big problems with TNM is there is virtually nothing that the GOP ever does that most so called moderates here ever find good in the least.

Pretty much by definition that makes them not moderate.

Rick’s puff piece on the democratic convention nearly had me gagging.
I have made no secret of the fact that I think Romney is little more than Obama-lite. But that is not an endorsement of Obama.

I did not vote for him, but I was very glad when Obama was elected. both of my children are minorities. His election sent a message to them that they too were americans, were equal to the rest of us – though both are deprived the right to grow up and become president.

I also desparately hoped both for my children and the country that Obama would prove to be Bill Clinton without the sexual pecadillos. That his feet would grow to fill the shoes. That he would back away from the lunacy that we are the policemen of the world. That he would bring about the more open government that he promised, that he would end the trade of liberty for a false sense of security that 9/11 drove us into. And finally that he would grasp that the progressive utopia he sought could not come about in a nation that can not pay the mortgage on what it has already bought.

The president has proven at times to be an eloquent speaker. I think he is sincere in many of his beliefs. But in the end he has been an abysmal failure. Good intentions are not enough. When you can not pay your mortgage and feed your children – do you want the man who tells you to cancel your cable, and cell phone and get a job, or the one who tells you to buy a new flats screen and hope for the best ?
Do you want someone who feels your pain ? Or someone who kicks you ass ?

Pres. Obama is a nice guy, but it is past time for him to be laid off. Unfortunately Gov. Romney is not the replacement we really need.

Apparently, the GOP should have just gone along with whatever Barry wanted, because, why? If you are believe that governments should be smaller and you are working with Obama, why would you believe he would meet you ”
“half-way.”

Sorry, the guy is an empty suit, which one might have known, given his absurd credentials for the job.

More and more the strategy of giving the left exactly what they want appeals to me. Where would we be right now if democrats had passed card check ? Cap and Trade ? …. What if Scott Brown had not won in Massachusetts and democrats could have polished PPACA into what they really wanted rather than being forced to adopt the bastard version that was fillbuster proof ?

Do you think Romney would be the GOP candidate with unemployment in double digits, energy prices soaring, Healthcare going down the tube, and businesses everywhere raising prices to cope with unions acquired through coerced ballots ?

“Sometimes the gods punish us by giving us what we want”

The successful Tea Party revolt in 2010 came too soon. Four years like Pres. Obama’s first two would have given us the real chance to see the benefits of progressivism close up.

Then again how long do things have to be bad and how bad do they have to be before we grasp it is the medicine that is killing us not the disease.

I have often thought of total capitulation as a strategy, just to test the hypothesis. That said, we don’t have to do that as France is getting ready to do that for us. Let’s see how well our buddy Holland is going to fare.

Because Bush was fisacally irresponsible (with alot of help from both parties) – Obama gets a free ride on trippling down ?

Have you ever considered the possibility that obstructing the president and every turn might actually be the right thing to do ?
If Romney is elected, there are numerous issues that I would expect and demand democrats to resist to the fullest of their abilities – would that make them evil ?
If wining an election entitles you to get your own way – then aren’t that minority of elected republicans in 2008 entitled to demand their way too ? After all a majority of their constituents voted for them to do exactly what they are doing.
If opposing Obama was so unpopular why were even more republicans elected in 2010 ?

You complain about political polarization, but by framing all arguments ass essentially about good and evil, you force the very polarization you decry.

Rick: If we send school girls out to do battle in the global economy, we could be in big trouble. Reread your analysis on the DNC convention. You’ve got to admit it couldn’t be improved upon by an operative for the Dem party. Where is the insight, the recognition of all the half truths and flat out lies being projected to the American people as gospel? Sure, all conventions are just large theater now, and the GOP did some truth stretching as well, but this was no discerning analysis. It was more like a gushing tweet from an Entertainment Today reporter. Consult your inner cynic. We are all being sold hogwash, designed to distract us from the failures of the political party currently in power, and scare women away from giving the alternative party a chance to apply different economic policies.

By the Fauxcahontas logic, Churches are not people, Labor unions are not people, governments are not people. In any instance where people act as a group for a common purpose, they lose those rights they possessed as individuals.

One individual is a person, ten are still people, ten thousand acting together are still people, Ten million who agree and act together on only one matter – are still people.

Each has a heart, many have kids, they laugh, they die, they get sick, ….

You can not do to a group, what would be immoral to do to an individual.

Like it or not a corporation is just alot of people. People form churches in the hope of spiritual benefit, they form corporations in the hope of improving their standard of living.

Inverting Fauxcahontas logic – are those of us who can not have children – not people, those who can not dance – are not people ? Are those of us who are healthy not people too ? Are those of us who are happy not people ? Those who have never been in love not people ?

My wife is a graduate of Penn Law and studied under Prof. Warren. I have actually read some of her work – including the famous people are going bankrupt from healthcare costs paper – which like many newspaper headlines actually says pretty much the opposite.

I think she was a far better Law Professor than politician, and hope Harvard gets her back soon.

Elizabeth Warren’s speech was simply gag-worthy. Here is this woman, who lied and cheated her way into Harvard, twisting Romney’s words, raking in donations from Wall Street, while demonizing it and glorifying OWS, and talking about paying one’s “fair share”, although she refused to pay the voluntarily higher rate that MA offers to it’s wealthiest taxpayers (5.8% as opposed to 5.3%). I find her to be a despicable hypocrite. She is currently running well behind Scott Brown, so hopefully, this is the last we’ll hear from her.

Jennifer Granholm was a hoot….if I didn’t know that she was an actual speaker at the convention, I would have thought that she was acting in a Christopher Guest film about politics. And, the Big Dog was great….he was like a skilled defense attorney, defending his guilty client, using all of the rhetorical tricks and half-truths he could muster. And the spectacle of an impeached President, one who had been accused of rape and sexual assault, front and enter at the convention of Oppressed Womyns was rich (pun intended).

Obama…well, I thought he was weak, but, then, I have never been impressed by his “mad oratorical skillz”. I think Michelle was a far better speaker. What I heard him say was:

“Bush caused this bad economy. It was the worst ever. I am the president, so I know how hard it is to fix this really bad economy, and Romney does not, because he is not the president. It will take a long time to fix it, so, if I get a second term, don’t expect too much, but, I have a plan and it will creat jobs. You kinda expected too much from me the first time, so don’t make the same mistake twice. But I am the president and a citizen, and we’re all citizens and we’re in this together.”

And one more note: Obama signed off on the original platform, which had been changed to reflect his own policy on Jerusalem. He had plenty of time to insist that the changes, including the deletion of “God-given” be put back…but he didn’t do so until it created a huge outcry. So, now the Dem platform is at odds with the President’s stated position, just as the GOP platform is with Romney’s on abortion.

But I do not think she cheated her way into Harvard or Penn.
i do not beleive her claims to be Native American had anything to do with any job she got – though I do beleive Penn and Harvard capitolized on them.
I do not think based on the evidence available there is anything wrong with her claim to american indian ancestry – just is I can claim there are african americans in my heritage based on family lore. I do think that receiving special preference for such things is idiotic even if true. And I think she would have been wise to back away from the issue.

Warren is the orignal source for the “you did not build that” meme. Though atleast she had the excuse of being a neophyte politician. Why Obama ever went there is incomprehensible to me. Anyway I will be happy to take her to task for that.

I think that when my wife had her as a professor at UofP she was a good law professor – and she should return to the job she is good at.

Dave, Warren may very well be a good professor. But the Ivy League simply does not hire Rutgers Law graduates who began their teaching careers in Texas. Mind you, my son got his JD at Rutgers Law, I think it’s a fine school. Warren was listed as a minority faculty member at Penn, and that could not have been unknown to Harvard when she was hired, since she was listed as a minority there from the start.

Reportedly, she did not list her ethnicity at all on her applications….so technically, she did not lie to get hired….but, come on. And, frankly, if she were not the holier-than-thou, “the system is rigged,” “rich people get rich by screwing everyone else” politician that she is, it wouldn’t bother me so much.

I think this post makes it perfectly clear your not a moderate – you see the world through the rose colored glasses of a democrat.

I personally paid little attention to either convention. Overall they were both dull and uninteresting. To some small extent Romney succeeded in making himself a bit less cold and more human. And the GOP managed to get some mileage out of
“you did not build that”, but as dull as the republicans were, the democrats were even duller.

Whatever you are smoking had to have been pretty potent to miss the irony of Granholm the job destruction queen speaking about creating jobs.

Sandra Fluke has successfully turned birth control into a right of sufficient magnitude to overcome freedom of religion – what come next – twinkies ?

The only good news in the auto industry bailouts even fro democrats is that Bush started the process. Have you actually looked at what really went on ? The order of corruption is worse than a glue factory. Rather than play by the rules, government pillaged private bondholders. If you do not think that matters, wait until the next major business needs a bridge loan to survive. We have essentially turned government from the lender of last resort to the only lender. Non-union factories that were running profitably were destroyed to accomidate union demands.

If the auto bailouts are your idea of a glowing accomplishment – god help us all.

Ultimately little of consequence happened in Tampa and nothing in charlotte,
That you have such a lopsided view is deeply disturbing.

What a brilliant ruling by the United States Supreme Court on the affordable health care act (Obamacare). Stunningly brilliant in my humble opinion. I could not have ask for a better ruling on a potentially catastrophic healthcare act than We The People Of The United States received from our Supreme Court.

If the court had upheld the constitutionality of the individual mandate under the commerce clause it would have meant the catastrophic loss of the most precious thing we own. Our individual liberty. Thank you! Thank you! Thank you! Supreme Court.

There is no mandate to buy private for-profit health insurance. There is only a nominal tax on income eligible individuals who don’t have health insurance. This is a HUGE! difference. And I suspect that tax may be subject to constitutional challenge as it ripens.

This is a critically important distinction. Because under the commerce clause individuals would have been compelled to support the most costly, dangerous, unethical, morally repugnant, and defective type of health insurance you can have. For-profit health insurance, and the for-profit proxies called private non-profits and co-ops.

Equally impressive in the courts ruling was the majorities willingness to throw out the whole law if the court could not find a way to sever the individual mandate under the commerce clause from the rest of the act. Bravo! Supreme Court.

Thanks to the Supreme Court we now have an opportunity to fix our healthcare crisis the right way. Without the obscene delusion that Washington can get away with forcing Americans to buy a costly, dangerous and highly defective private product (for-profit health insurance).

During the passage of ACA/Obamacare some politicians said that the ACA was better than nothing. But the truth was that until the Supreme Court fixed it the ACA/Obamacare was worse than nothing at all. It would have meant the catastrophic loss of your precious liberty for the false promise and illusion of healthcare security under the deadly and costly for-profit healthcare system that dominates American healthcare.

As everyone knows now. The fix for our healthcare crisis is a single payer system (Medicare for all) like the rest of the developed world has. Or a robust Public Option choice available to everyone on day one that can quickly lead to a single payer system.

Talk of privatizing/profiteering from Medicare or social security is highly corrupt and Crazy! talk. And you should cut the political throats of any politicians giving lip service to such an asinine idea. Medicare should be expanded, not privatized or eliminated.

We still have a healthcare crisis in America. With hundreds of thousands dieing needlessly every year in America. And a for-profit medical industrial complex that threatens the security and health of the entire world. The ACA/Obamacare will not fix that.

The for-profit medical industrial complex has already attacked the world with H1N1 killing thousands, and injuring millions. And more attacks are planned for profit, and to feed their greed.

To all of you who have fought so hard to do the kind and right thing for your fellow human beings at a time of our greatest needs I applaud you. Be proud of your-self.

God Bless You my fellow human beings. I’m proud to be one of you. You did good.

Oh, and take a deep breath before going off the deep end. If i have to put up with the monty python allusions you can tolerate this.
Its just good fun – but like every good jab there must be an element of truth for it to work.

jacksmith..Check out the system in the Netherlands. The Dutch have one of the best healthcare systems and have one of the highest longevity in the world. They are also one of the European countries that we all say we want to copy.

Well their system is two fold. If you are considered one of the richer citizens, you buy your own insurance. If you are not, the country gives you a voucher and you buy whatever policy you want. (Source Clark Howard Show 9-4-12 confirmed by resident of the Netherlands).

This system works well, keeps cost down and quality high. Does it sound something like the Ryan plan?

And gets government out of somehting they do not know how to operate, thus the billions each year in Medicare fraud they can not identify or control?

Please go back several topics ago, there is a long discussion about how fantastic the Netherland’s isnt.

At the same time I would note as you have started to, that the healthcare systems in most of europe are far from what american progressives paint them to be. They tend to be far less distortive than even what we had prior to PPACA. Most find some way of compelling people to self ration their own healthcare – either by requiring payment of a sizeable fraction of costs, or paying part of the cost of the insurance.

Unlike Woodward, i do not think we dodged a bullet in with the deficit deal. Failing to reach a deal would not have been the end of the world,, it would not have been all that bad. One of the problems with moderates here is this belief that any resolution is better than conflict or none.

Our credit took a hit, not because of the political strife associated with reaching a deal – but because we did not actually solve our problem. The so called fiscal cliff coming in 2013, is a combination of two things – the expiry of the Bush tax cuts – which would not be the end of the world, but would be economically harmful. The imposition of spending cuts that were negotiated as part of the debt ceiling deal – failure to follow through on those would likely be disasterous. It would essentially mean the entire debt ceiling conflict was a waste, that neither party takes our debt seriously.

Predicting what ratings agencies will do is difficult – they have always been political, but are more so today. But backing away from the spending cuts would cause me to think twice about investing in the US government.

No! No! No! you have not been listening to our Dear Leader – it is impossible for greedy capitolist pigs to earn money, money can only be legitimately earned by the proletariat, and then only with the help of their state comrades. The NEP does not come until after the Bourgeois has been brought to heel.

As to her academic carreer – female is considered a minority – I do not know about Harvard but there were very few female professors at UofP. Following the story one will note that in some instances Warren was “advertised” as a double minority.

UofP currently has a female visiting Professor from Rutgers – that is a common means of moving from one law school to another.

Despite the current hype Warren’s purported native american identity was not common knowledge when my wife attended UofP. Warren was strongly courted by Harvard while my wife was at Penn. Again this did not come up among students or the public.

Warren’s public political and legal ideology atleast at Penn was far from that of Elizabeth Warren politician.

She has proven to be a very clumsy politician. I fully agree that her holier than thou attitude just begs for the come-up-ance she appears to be getting. Her handling of the issue has been abysmal. This could have easily been dealt with.

There are disturbing aspects to this. I do not believe we should be held to legal standards of proof regarding our ancestry – except when that claim confers legally privileges.

Rand Paul got into political difficulty for expressing the libertarian view of the Civil rights act – government should be prohibited from discriminating against anyone for any reason outside of violating the rule of law. Private actors should be free to make any decisions they make for whatever reasons they please.

If Penn and Harvard chose to hire Warren because of he claimed native american background, absent any government inducement or benefit – vetting that claim just as valuing it is their business.

If Harvard Law wishes to hire only female LGBT professors that is their business, conversely Tulane may chose only Neo-Nazi’s.

For the most part private discrimination is a self punishing act – and government should stay out of those.

The fundimental problem with Warren’s native american claim is not its dubious strength, it is not that Penn or Harvard promoted it, it is that government sanctioned it as one of few legitimate basis for private preferential treatment, and for preferential treatment by government.

One of the problems with ALL these government efforts to do good things is the absurd consequences.

Why do we care whether Warren claims native-american heritiage ?
Because government dictated that as a legitimate basis for discrimination.

The idea that was stated somewhere in this chaos that if Romney and the GOP win, their only object is the economy and no other GOP agenda items should worry voters is laughable nonsense.

If anyone thinks that the Mona Charens of the world are working night and day to elect a GOP majority and then will sit back after the election and demand nothing, well, that IS delusional.

I’ll agree that abortion is mostly a dead horse that gets beaten each election, there is not much room for change there (and I’ll note here that for purely human and non religious reasons I think that that extreme pro abortion sentiment the dems tap into is horrifying, If I had been Warren Burger I’d have set the limit at 3 months other than to save the life of the mother).

On the other hand iabortion is no more of a dead horse than the They’re going to take your guns away, riff the GOP throws at the Ted Nugent crazies in their base.

My biggest concern is the safety net, which is especially needed right now and is despised by the conservative base.

A war with Iran also is not a happy prospect, that is not the economy but it will certainly have a huge effect on the economy.

To the extent the safety net is an issue the GOP is winning it.
While they have something on the table that many are not happy with.
Obama is speaking from both sides of his mouth, first saying things will remain exactly as they are while already having in place in PPACA radical cutbacks in Medicare.

The fact is things are not going to continue as they are. One party has atleast admitted that publicly.

Absolutely there should be a public debate – preferably an honest one.
If you are going to vote for Obama because you believe his ideas for addressing that safety net you are planning on sinking with, then the least you should do is demand that he actually tell you how he intends to solve its problems.

Obama and democrats have seriously alienated Jewish voters. He will still get a majority, but Romney may get more than even Reagan did – probably enough to win florida.

Regardless of who is elected little is likely to change regarding Iran.
Neither party is prepared to go to war with Iran. Israel may or may not strike them, but they are not going to effect regime change. Ultimately we are stuck with the Iran we have – atleast until its own people are prepared to change it.

Had Obama not killed EIS a nuclear Iran would be less scary.

Regardless, foreign policy is not going to be a key issue in this election.
Obama has been bad though tolerable, Romney has no credible reason to the perceived as either better or worse.

I would also note that the views you expressed above on Abortion are closer to those of the GOP than the Democratic party.

I am not looking to start a debate on abortion. It is a very nasty topic, and my own views are heavily influenced by those of Lawrence Tribe and would not make either side happy – there is an absolute right not to be forced to use your body to sustain the life of another, even if the excercise of that right results in death. Endowing the pregnancy with full human rights would not alter that.

In a different context this is no different than you can not force someone else to give up a kidney to save another person.

Conversely there is no right to terminate the pregnancy – only to end its dependence on your for life.

While consistent with most of the rest of our law on similar issues, that is not a view that is likely to make either the right or left happy.

Todays NYT editorial, which I will admit is no less biased that what the WSJ publishes, they are a clearly liberal voice. But still, some interesting logical points on Romney’s healthcare ideas.

“If the first weekend of Mitt Romney’s general election campaign is any indication, the country is in for eight weeks of wild, often random answers to some of the most important policy questions. Voters trying to understand the positions of Mr. Romney and Representative Paul Ryan are going to have a harder time than ever.
On issue after issue raised in the first weekend of interviews after the conventions, Romney and Ryan actively tried to obscure their positions, as if a clear understanding of their beliefs about taxes, health care or spending would scare away anyone who was listening. Aware that President Obama’s policies in these areas are quite popular once people learn about them, the Republicans are simply sowing confusion. Here are a few examples:
HEALTH CARE After more than a year of denouncing Mr. Obama’s health care law, Mr. Romney said on “Meet the Press” on NBC on Sunday that maybe parts of it weren’t so bad. “There are a number of things that I like in health care reform that I’m going to put in place,” he said, such as coverage of pre-existing conditions.
There’s just one problem: guaranteeing coverage to people with serious diseases means that sick people would sign up en masse for coverage, driving premiums up for everyone. That’s why Mr. Obama’s law required everyone to have insurance to spread the risk around.
Mr. Romney remains opposed to the mandate (though he supported it in Massachusetts). So his campaign was forced to issue a clarification: he supports coverage for pre-existing conditions only for those with continuous insurance coverage. That jettisons sick people who have lost their jobs or never had coverage. It’s been the law since 1996. But those who only watched the interview won’t know that.
TAXES As an important independent tax study showed, Mr. Romney’s plan to cut tax rates for the wealthy by 20 percent and offset the lost money by eliminating loopholes won’t work because there aren’t enough available loopholes to make up for the rate cut. Taxes on the middle class would have to go up to keep the plan from lowering overall revenues.
Asked about this on “Meet the Press,” Mr. Romney said the study was wrong and promised that the plan would work. He cited a Harvard study, among others, that backed him. But that Harvard study, by Martin Feldstein, Ronald Reagan’s chief economist, does no such thing. As The Washington Post has noted, Mr. Feldstein’s study showed Mr. Romney’s plan would require substantial tax increases on taxpayers making between $100,000 and $200,000, which most people would consider the upper end of the middle class.
DEFENSE SPENDING On “Face the Nation” on CBS, Mr. Ryan tried to wriggle out of admitting that he voted for the law that led to the sequester of $500 billion in defense spending that he is now blaming on Mr. Obama. He told the interviewer, Norah O’Donnell, that she was mistaken in stating the plain fact of his vote. He fully supported the Republican Party’s decision to hold the government’s credit rating hostage for spending cuts and is trying to hide from that.
Mr. Romney thought the weak economy would give him a pass on specifics. But voters expect answers, and the Republicans are demonstrating only shallowness.”

I teach health care administration and economics. I can tell you the US health care system is in a sad state of affairs, largely tied to governmental actions, laws, funding, and regulation. Interestingly, every band aid has failed and still, the policy wonks and law makers keep going down the same tunnel, looking for cheese. Perhaps one day, they might wake up and say: this isn’t working, let’s toss most of it out and start again.

Have a question for anyone. How does the ACA impact high deductible insurance plans with HSA’s. My son-in-law works as an administrator for one of the largest insurance providers in their HSA division. He stated their business has boomed since teh ACA came into effect with employers changing from 80/20’s and 70/30’s to high deductibles and HSA’s meeting the section 223 of the internal revenue code.

I would have thought the trend would be in reverse if the ACA was to provide affordable insurance coverage. This seems to be the reverse impact.

Medicaid for everyone???? You may want to do some research in your area and find out how many doctors will accept Medicaid patients. In many states, visiting a doctor for what is a intermediate level appointment pays less than getting the oil changed in your car. And they have to cover the cost of the recptioonist, the RN/LPN salary, their salary and any supplies you use.

No one in government has a clue on how to handle healthcare. In about 10 years, 100% of all tax revenues will be going to healthcare according to some sources close to federal spending. And the ACA is not going to fix the problems for the underserved population that sign up for the exchanges. Exchanges will have reimbursement rates based on the Medicaid programs and few qualified physicians accept that government program coverage today. Why does anyone beleive they will begin accepting it in 2014? That is why there are so many Medicad patients in the hospital ER today.

Ah, the just get rid of the system solution. Yes, that would get a lot of legislative attention, its a certain vote winner. The healthcare system is a mess, just get rid of most of it (how?) and start over. Without causing complete chaos and destruction that would get the party that proposed it kicked out of office for the foreseeable future, please.

I honestly tried hard to edit this to remove most of my sarcasm, please excuse the part that remains.

You really don’t read very well, do you. When I say “get rid of the system” I mean taking a look at the health care system with a clean sheet of paper from start to finish.

If one believes we have a “cost problem” and then attempts to fix that by adding buying power to those who have little, we can expect to: exacerbate costs, not lower them. How hard is that to understand?

This conversation needs to start with: what are the drivers of costs: Unit prices and consumption. What drives unit prices? Cost of resources, regulation, etc. Oh oh, too many sacred cows to deal with.

To wit: does it really make sense to have 50 states license medical practicioners? Does it really take 11 years to train a competent physician? Do hospitals really compete or are they a protected oligopoly?

This is very complex stuff and candidly, I don’t expect you to understand it, and I do expect a sacrastic response. It is the stuff you deal in.

Oh I dunno, I think I read what you wrote. If you have more to say with a bit more detail, then I can respond.

Doctors, hospitals and medications are not economically equivalent to automobiles or stereo systems; in the public mind; they do not obey the law that he who has the most money gets the best, he without enough money (and his children) gets the worst or none. That economic law is not politically or morally acceptable as it is for most other economic commodities. Thus the dreaded hand of government and regulation enters the equation. I hear you quite clearly , you are implying using a few choice words that we should remove them and all will be fine. I really AM going to become sarcastic in a moment. You have studied this matter and yet still seem to remain utterly naive to certain realities; health care is a public matter, government will be in the thick of it. If that is not what you are implying then accept my apologies.

Like it or not Americans and most people who live in first world nations can live with the idea that he who has the most money can buy the best healthcare, but they cannot live with the idea that he who has no or little money (and his children) gets little or no healthcare, so the standard economic thinking collides with public morals and those who try to see health care as a field of pure economists are just going to have to adjust to that or be laughed at or ignored by serious people.

I am NOT saying that healthcare simply escapes from the laws of supply and demand, of course it does not.

Finding a way to distribute healthcare in a socially fair way IS a hugely complex issue yes, but the attempt to treat health care as just another economic commodity is quite insufficient, and anyone who thinks they can bring that about (and that view does exist) is dreaming.

Of course, I said none of what you imply. Does government have a role in HC. Yes, they do and should. Has the role been effective? Yes, in driving costs up and efficiencies down. Can government help insure that needed care is delivered? Yes.

Have they done so efficiently and with a logical approach? No. Has government added regulations and costs that produce no value? Yes, Has government been co-opted by provider cartels? You bet. Does the government sit idly by while approximately 100,000 caused deaths PER YEAR takes place? Ah, yes.

I would suggest you not debate me on HC. You candidly don’t know the first thing about it.

To wit: the ESTMATED waste and fraud in the Medicare system is around a Trillon dollars (maybe). Assuming a functioning market-based system (with say, vouchers) do you really think this nonsense would be tolerated?

Of course you did not say any of that, that would be because you actually said almost nothing comprehensible at all. Here was your entire policy prescription as a so-called expert and teacher: ” Perhaps one day, they might wake up and say: this isn’t working, let’s toss most of it out and start again.”

Yes, very articulate, and it only sounded stupid and naive because it IS stupid and naive.

The reasons that you have not heard anyone on either side of the aisle propose your vague solution do exist, try to understand them instead of wasting my time horsing around under the heading Anonymous, where, believe me, you were quite conspicuous.

Debate you on this subject? So far you have managed to sound like a child in your own field of expertise in a debate with a molecular biologist.

Oh, I had better not even Think of debating you on this subject, you are a badass economist and I’m just a tadpole. Kid, let me tell you something, before every little after school fight I had in grade school my opponent would try to use words to puff himself up, oh what he was going to do to me, oh, I had better run away, oh, he was going to kick my ass so bad. Then the actual fight would begin and the hot air evaporated.

You could not get rid of healthcare if you tried – what you can do is chase government out of it.

I would be happy to agree with many on the left that we have possibly the most screwed up health insurance and healthcare system in the world. Private insurance subsidizes, the uninsured, HMO’s, medicare and Medicaid. Private insurance is burdened with the the worst regulation at both the state and federal level. There are rules for everything. Competition is nearly non existant. Government already mandates provisions that failed in europe more than a decade ago.

And we are preparing to make things even worse.

We are rapidly approaching the point where we have already killed the baby all we have left is a corpse rotting in the bathwater – yes, it is time to throw it out.

The fiscal crisis hit Iceland extremely hard, the scope of the problem was well beyond the countries ability to cope with and it went bankrupt. Standard of living dropped dramatically. GDP dropped more than 10% in two years.

But the nation is now recovering with 3% growth – depressed slightly because of concerns over the future stability of the EU.

I have a colleague that teachs health law. She admits, that, like tax law, no one really understands the totality of health care regulation. It truly is mind-boggling how many laws most healthcare providers now violate on a daily basis.

And of course, that is the point, the fines and penalties keep the regulators going and going.

The problem with arguing with people who have extreme views is that one winds up finally just sounding like the polar opposite. Which, actually, I am not. It would be great to simplify everything, can you propose a mechanism to do it that passes the political and npractical laugh tests, or are you going to continue to propose things that have you scratching your head for the rest of your life wondering why neither party will touch your ideas?

Propose something real, propose an actual specific regulation or practice to change, not to an internet yack board but to a regulatory body or lawmakers. Perhaps you will come up with some suggestion that actually has merit, after it has been studied. We certainly need to do something and if you have good ideas propose them in a real environment, handwaving on the internet is just posturing.

But, hint, blowing up the system is not a real world option.

Enough of this for me, you guys are not giving me much of a real challenge and I’ve got tennis to play, so ta ta.

And most of the violations are due to the complexity of the billing regulations and the thousands of codes used to bill for different procedures. But that keeps millinons in jobs from consultants, their staffs on up the government employees writing the rules and trying to detemine where fraud is intentional.

Hey jbastiat, no real answers from our health care economics expert to my health care comments so its back to the clever Anonymous ploy? Sort of about as effective as the old 1964 civil rights act ploy was? Boy, are you good at finding dogs that wont hunt.

And Dave is glad to prove that the lets get the government out of healthcare lassaiz faire Libertarian wacko faction is alive and well and poisoning the GOP with ideas that are real vote getters.

The libertarian phase will blow over, you can’t form your own real party that gets votes and the brilliant ideas ya’ll bring to the GOP are going to get you an eviction notice if Romney loses.

I have no idea why that post was labelled as “anonymous” as it reads differently on my end. I can’t talk health care with a dimwit like you. I get paid (a lot) to consult. Send me a check and you can have my ear.

OK, this debate is getting a little nastier than necessary. I think we (not including Dave) can actually find a simple common denominator for agreement on healthcare: 1) nobody should be bankrupted by serious illness; 2) the free market alone can’t provide the medical insurance everyone needs to avoid bankruptcy due to illness; 3) all managed healthcare, public and private alike, is bureaucratic and inefficient. I’m sure Dave would take issue with points 1 and 2; I don’t think Rich would. Am I wrong?

Rick, the healthcare issue and rising cost problems a far greater than one can imagine. medicae was a fantastic solution in 1968 until it became a reality. Patients did not see the growing problem with the program when treated, but providers found that from 1968 to 1983 they could spend any amount of money on equipment, supplies and labor and for most, over 50% of the cost was passed on to the government since Medicare payed what is cost to provide that service. So there was no incentive at all for providers to control cost. Then came DRG’s where patients were covered by the diagnosis. Great idea, but then came the consultants that knew how to code the services in a different order and move the diagnosis from a lower paying one to a higher paying one. And on and on, each change the government has made has been met with a counter move by consltants to undo their cost savings.

As for the solution to our healthcare cost problems, the only answer to truely control cost is to nationalize all hospitals and clinics, make physicians, nurses and healthcare workers government employees and have a one payor system that gets consultants out of the game that can come up with solutions to every government regulation they make in D>C>. If it cost a hospital one dollar to provide supplies for a service, they get one dollar back to cover their costs so they can pay the vendor. Nothing more.

Until that happens, cost will not be controlled as consultants will find every loohole in a regulation to milk the system.

What is ironic about Medicare is that from the beginning, the lawmakers knew it was a Ponzi scheme and most actuaries knew that the Medicare assumptions were garbage. In fact, the first few years of Medicare, costs exceeded estimates by 10 times the estimates.

All of us should be allowed to go to the moon.
No one should have to die.

There are very very few things that are absolute rights – one of the reasons is that rights impose no burden on others, they have no cost.

Anything that actually has a real cost to others can not be a right.
When there is a real cost – you can not make decisions without counting cost – which is precisely why freedom works, because each of us has diffierent values and measure costs differently.

When you say everyone should this or no one should that, you are either implicitly presuming some form of cost control, or you are accepting that we should sacrifice everything else we value in order to acheive your desired ends (and still we will fail).

Once you accept that there must be some form of cost control – you have already rejected your own premise. You have accepted that whatever absolutist claim you have just made is going to be implicitly limited by cost.

All that is left is deciding how we are going to ration whatever you have just promised.

We have lots of real world practical experence with myriads of forms of managing scarcity – rationing – cost control.

Allowing free people to make their own decisions based on their own values, is the only way that has ever worked for pretty much anything.

1) According to Elizabeth Warren’s infamous report on Healthcare and Bankruptcy Healthcare was a factor in less than 30% of all bankruptcies, and of those the average medical expenses discharge were less than $2000. At the peak of bankruptcies in 2009 than is 840M in total medical expenses for everyone for the entire year discharged in bankruptcy. That is 1/100 what we paid to bail out GM.

This is a sufficient justification radically change the entire healthcare system ?
2) Prior to the advent of health insurance people still got sick, still received treatment by doctors and hospitals – even poor people. Costs as a percent of income were substantially lower than today.

Regardless, everyone getting all the healthcare they might want free is not possible. You are absolutely compelled to ration healthcare in some other way. You may not like markets as a solution – but there is not another solution that has ever actually worked.

I just checked online and a family of 4 (with two adults over 50) can get a 10,000 deductible policy covering everything for $300/month. that is less than $500B to cover every single family in the US with a high deductible plan. That is LESS than we are paying for Medicare.

That is 15% of the poverty level income for a family of 4. That is about 1/2 the cost of the food stamps that the same family of 4 is entitled to.

The bankruptcy issue is largely a smokescreen. It is or can be handled by the Medicaid program. However, when one simply asserts that no one is at risk for this, then suddently fewer people buy protection against it.

You accurately diagnose the problem and then prescribe the wrong medicine.

Nationalizing the system fixes nothing. Among other reasons because the root problem is not that providers find ways to jack up prices – though I will be happy to agree that they do – that happens anytime a service involves government. In fact the price of a government provided service even goes sky high – or higher when the government does everything.
Would anyone dream of having the government actually build B2 Bombers or Aircraft carriers – as unbeleivably expensive as private contractors make these, we instinctively know that government would do far worse.
Current estimates are that the real costs of Englands NHS are atleast twice those reported – and those are horrendous.

When you make something free, it immediately become greatly over consumed. Seniors are on the whole no healthier than they were in 1965 but they consume more than 3 times as much health services as they did then – and would likely consume even more absent practical limits.

Regardless of Rick’s rants to the contrary – healthcare is not actually special. i deliberately use words like value – each of us has different values. Most of us value healthcare, but the only means of knowing how much we value healthcare relative to anything else is to price it on the market.

Like it or not that price establishes how important healthcare is relative to everything else that we also value. Or atleast it does so in an actual free market.

It is the price of healthcare that tells us its value in comparison to cars and shoes, or food, and cloths, or vacations or ….

Rick wants to rant about bankruptcy – people go bankrupt for many many reasons. Some people go bankrupt trying to “build something”. Few are “evil”. Most took one risk or another and lost – maybe by chance.
Bankruptcy is supposed to be a means of starting over. but it is not supposed to be free of cost. If you roll box cars on a health insurance bet you lose. If you gambled 3,000/year against the odds of a catastrophic health disaster – going bankrupt is appropriate. The people who paid for the healthcare you got despite you poor gamble get paid something – but not everything, and you lose much but not all of what you have. And are justifiably labeled a bad risk for years afterwords.

asmith, you make very good points on how government involvement in anything drives up costs. And with healthcare, you also show how difficult it will be for any human in any field of study to come up with a solution to the healthcare costs issues in this country.

We do not have a healthcare crisis, but we do have a healthcare cost issue in this country. And I go back to a comment I made in another post that government can not improve the economy, but the government can surely mess up the economy through regulatory legislation. That holds true for healthcare also. One tremendous cost to Americans is the cost of drugs in this country, while just across the border in Canada they are paying fractions of our cost due to a different regulatory climate. And Canadians do not seem to be dying at any faster rate from bad drugs than we are in America.

We have other regulatory issues that drive up costs. Government pays for an inpatient service based on a flat rate based on the discharge diagnosis. The best way for providers to reduce costs is to reduce the time they have to spend with the patients. What once was a 10 day stay in a hospital is now a 3 day stay. And what happened, readmissions have increased to about 19% for Medicare patients who were not ready for discharge, but were discharged anyway to cut costs. Now the government has had to come up with another regulation that will greatly reduce reimbursement for anyone readmitted to a hospital for any reason within a specific time period from a previous discharge. And when government reimbursement is reduced for 19% of medicare admissions, then others will have cost increases to cover the that reduction. Another cost shifting to private ay patients.

And we will not discuss the issue with 5-7 million dollar machines with an expected usefull life of not more than 5 years. Why do they cost that much if they only last 5 years? That can be for a future discussion.

Indeed. US Health care inflation was essentially identical to the overall inflation rate from 1920-1971. Thereafter, it spiked sharply higher and has never really come down. What happened? Well, in 1966 and 1967 the Feds passed Medicare and Medicaid.

Supply and demand still matter. Worse, since then, the Feds have slowly but surely taken over larger and larger amounts of health care. HC inflation will never come back down, except through explicit price controls, rationing, or both.

jbastiat.. You state that health care inflation was the same as other inflation until 1971. That is because Medicare and Medicaid came into existence and the government paid the “cost” and not the charge for the service. So that meant 50% of the providers business did not cover any profit. After 1983, those two programs did not even cover “cost”. Today, Medicaid covers about 35% of the cost to provide the service and Medicare covers about 45% of the cost. With 50+% of your busincess loosing money at a rate exceeding 50%, that means the private payor is covering their cost, their profit which is usually 5% to fund future equpiment and facility renovations and the 50+% of Medicare/Medicaid costs and profit not covered by the government. So if inflation is 4% overall, then the rate of inflation for healthcare is going to be targeted at 8% without any adjustment for new technologies, new high cost drugs and new high cost supplies.

If Ryans voucher plan came into existence, you would find that those patients now covered by a system tat does not pay their cost shifted to a private pay insurance plan that would provide better rimbursement to providers, thus reducing the rate of inflation in healthcare.

If you can not get 100% of the market into insurance plans that pay adequate reimbursement and stop shifting cost from the majority (Medicare + Medicaid+ other government programs like VA, CHIPS)to a minority (Provate pay insurance and self pay), then the only other answer is a less desirable program where the healthcare market is nationalized (not a choice of asmith and I agree) like in the UK. The current market, even with ACA is not working and won’t work becasue the minority is paying for the majorities healthcare cost.

I believe a market based system for HC reimbursement could work well in the long run. I don’t see any real effort to make that happen. Why in the world would the cartels and oligopolies support a system that would promote price competition.

Do you think that would ever happen? Seems like anytime someone in congres proposes any change to any entitlement program, they are demonized. Seems like the only time the electorate will accept any proposed changes to entitlements is when a crisis occurs. If before the crisis, those proposing any change stand a good chance of being defeated in the next election and if they wait until the crisis occurs, then people get pissed because they did not do anything. A can’t win situation.

No one is seeking to end doctors, hospitals, ….
In fact no one is even seeking to end insurance.

Nor is there some law of economics that says hw who has the most money gets the best.

A more accurate restatement of what I think you are getting at is that if you are wealthy enough you get to be a first adopter. You get to pay way way too much for the crappy early version of a product that does not work all that well – in return for having it before the masses.

And actually it does not matter whether we are talking ipads or heart bypasses.

Whether associated with health or pretty much anything else, we will always have different values, and unequal resources with which to obtain them.
The only means of precluding that is to impoverish everyone – and even that really does not succeed.

Healthcare is not a right – man has no rights that place a positive burden on others. No rights that do not exist absent government.

But even if we accept that somehow rights extent to healthcare – how is it that you determine what healthcare each of us is entitled to.
Clearly we are not each entitled to whatever healthcare we want without regard to cost – particularly when others will be paying the tab.

Ultimately you are forced to establish some criteria for limiting – rationing healthcare.
Otherwise your right to healthcare destroys everything else. This is one of the reasons that healthcare is not a right. You can not make an illimitable want into a right.

Like it or not your social safety net must be rationed. If you do not grasp that, there is nothing to discuss, you are far blinder than anything you have ever accused me of.

Once you accept that Healthcare must be rationed (which implicitly accepts that it is not a right), all that is left is the utilitarian debate over how.

I am sorry that the fact that rich people get to buy the crappy version of a good or service before everyone else offends you.

But even if we pretended the rich did not exist, free individuals making their own choices based on their own values – what is called the free market produces the best outcome for everyone. It does so whether we are talking cars of heart surgery.

It does so because we do not all share the same values.
You may be willing to spend every last cent you have for a few more moments of life. I my chose to give up a few weeks or months of my life in order to leave more to my family.

Leaving people free to make their own choices does not work perfectly, but every other so far conceived method works far worse – even for those you are seeking to help.

Health care is not only not a right, but it is a service that no everyone values the same. The problem with policymakers is that they think everyone wants and needs healthcare the same and that it is their highest priority.

That is where price comes in, as it allows one to understand who values what and why.

I just want to clarify something – avoiding bankrupting people is really your bottom line justification for whatever it is that you want to do to health insurance ?

We need whatever it is that you are pushing so that the approximately 350,000 people each year who are bankrupted do to healthcare costs – that average less than 2,000 each.

This is the unconscionable problem that the free market can not solve ?

I would note that if that is your argument – you have completely accepted my claim that this is all about values and money. You are trying to protect people from losing their money – because we already know that no one in this country actually is denied necessary healthcare regardless of ability to pay.

Avoiding bankruptcy is handled quite nicely by very affordable catastrophic insurance policies. The issue of course, is that these are not allowed to be issued in nearly every state and the new Federal law does not allow them either. Hey, you can’t have Sandra Fluck having to pay for birth control pills, can you?

“The problem with arguing with people who have extreme views is that one winds up finally just sounding like the polar opposite.”

You are responsible for your own arguments. No one else can say what you mean besides you.

If you think that somehow your argument have made you sound like the polar opposite – they were your arguments. Whoever was arguing with you did not make you say something different than you intended. Either you actually said what you believe or you made a mistake – regardless, the responsibility for whatever you say belongs with you alone. No one else made you say something.

My window into your real self is only through your words. But I strongly suspect that when your are starting to sound the polar opposite of the extremist you are ranting at – that it is your real self, your real thoughts that are coming out.

We have danced danced around trying to find the core values that purportedly make one moderate – there do not appear to be any. But I do not think you are without values. I think you value some things passionately. i think it is when you are contrasting yourself with those of us you call extreme that what you really think, what really matters comes out.

I do not think you are moderate – I think one some level you want to be moderate.
But ultimately I think you are like a gay man trying to fool himself that he is straight.
I think that like the gay man think being straight is normal, that you think moderate is “normal” or atleast the only acceptable thing to be. But the clothes don’t fit.
Your not happy trying to be moderate, you seem quite unhappy as a moderate.

I am very happy with who I am. I know I am not like everyone else – and I am ok with that. I do not have any problem being alone in my values.

Health insurance and health care are not the same thing. If this issue were reported on properly, so that the average voter could understand that they have been snookered into believing that Obamcare would provide everyone with health CARE, when the truth is that all that has happened is that we are now all required by to buy health INSURANCE…and not just any health insurance, not just health insurance that covers what our family needs and wants and protects us from catastrophic costs…but mandated coverage that includes contraception, abortion, sex change operations, ED medications (gotta have something for the guys), etc., and drives up, not down, the cost of coverage.

No longer will young people be able to opt for a high deductible, catastrophic coverage plan that provides basic protection against catasrophic illness or injury…the bankruptcy prevention that you want, RIck. And HSA’s under Obamacare become far more expensive and restrictive.

Cost containment, if it happens at all, will only come from rationing care. As Obama said, Granny will have to realize that, if she is too old, she’ll need to “take a pain pill”, presumably because most operations are just too expensive for an old lady who has lived long enough. Gotta use that money for all of the Sandra Flukes to buy her birth control.

And yes, there needs to be a way to provide a safety net of health care for the poor…..but, safety nets, last time I checked, anyway, were for services and coverage that people NEED, not every type of coverage that they DESIRE.

The Healthcare safety net has existed for decades – possibly centuries – atleast in this country.

No one needs to go without healthcare. PPACA improves nothing about the healthcare safety net. Frankly I do nto get it at all.

A part of the justification was to reduce medicare costs – but it does nothing to medicare except steal money from it.

It mandates health insurance for everyone. As you noted falsely conflating insurance with healthcare.

Rick justifies it based on the claim a failed risk on health insurance should not bankrupt someone – aside from “why not ? is bankruptcy really such a horrible price to pay for losing a gamble on health insurance ?
If I was without health insurance and required healthcare that bankrupted me, I would be happy alive. I would be thankful that doctors and nurses and hospitals treated me despite only getting ten cents on the dollar for their efforts. Regardless, is the small total cost of healthcare related bankruptcies sufficient justification for a program orders of magnitude more expensive ?

i also keep hearing these tragic stories, and this meme than end of life care dwarfs all other medical costs. I would think that insurance companies might know what costs what when they set their rates.

Why is it that comprehensive high deductible coverage typically costs less than 25% of what typical insurance policies cost – could it be that paying the insurance company to pay your doctor, is less efficient and more expensive than paying them directly ? Could it be that when we have to pay for our own doctors visits that we are more conscious of the cost, and weigh the need for a doctors visit against our other wants and needs – and often chose not to see the doctor ?

Sure, catastrophic coverage is affordable, but what happens to people with pre-existing conditions under the free-market system? If they’re denied coverage, they have no safety net. And I don’t think they should be forced to see their life savings eaten away before they’re eligible for Medicaid.

I don’t blame insurers for refusing coverage to high-risk patients; nobody should force them to lose money. I just think this is a perfect example of the limitations of the free market. In this case, the government should step in to supplement the private insurance industry. Think about it: we’re dealing with a relatively small number of people who aren’t covered by their employers and can’t qualify for individual policies based on their medical histories. I think such a small-scale safety net would have been fairer and more efficient than either Obamacare or the old “let’s see if you qualify for peace of mind” private insurance system.

Another issue we need to deal with (and this is a problem whether we have a private, mixed or single-payer system) is the refusal of coverage for certain medical procedures. One of my boyhood friends (and a high school classmate of ours, PR and Rich) was ruined financially while he was suffering from terminal cancer because he had to pay out-of-pocket for certain expensive procedures that his insurance wouldn’t cover. It was a pretty sobering experience to watch this happen to an old pal who had built a successful career for himself as an internationally known photographer.

Rick once again you bring up the issue with Medicaid coverage. And once again I would ask you to do some research and determine what percentage of doctors in your area accept Medicaid patients. In my area, most of the hospitals have had to create a physician leg of their corporation to make access to care for Medicaid patients available. They use the tremendous loss per year per physician as part of their community benefit calculation required by their not-for-profit 501(c)3 status. Even with these entities, access to care is still limited for specialist treatment, thus a huge descrepancy between the percentage of mediccaid patients getting high tech services in cardilogy and orthopedic surgical services compared to other non-governmental patients. The limitation is driven by the very low reimbursement rates payed by Medicaid. Most physicians would rather close one day a week and cut staff costs than to provide services for hours that equal a days work and lose money on each patient they treat. No business can open a suffer a loss on each sale and stay in business.

let us know what you find out about Medicaid in your area and how many Medicaid patients end up in emergency rooms becasue they do not have a primary care physician.

jbastiat..Is MA unique in its requirement that doc’s see medicaid patients? In NC, it is a freedom they have to make the decision as to what patient they treat. That is why the hospital I was finance director had and number of do’s that treated Medicaid patients, and each ones practice lost over 100K per year. It was our community benefit we used for 501(c)3 status.

I am going to do some research on this one. Interesting to find out how they can justify making a person in private practice accept government program individuals. I do understand the issue with tax exempt entities like hospitals being forced to accept medicare and medicaid patients, but a private practioner is a whole different animal.

One of the reasons you feel driven to extremes by some of the debates here – is that I am actively trying to get you to consider the limits of your own views.

If government at 45% of GDP is good why not 55%, why not 95% ?
I am prepared to defend 40%, 30%, 5%.
I know that 5% is not going to happen – but I know that it would work if we could get there.

I expect the same of you. If you are not willing to increase government to 95% of GDP why not ? What is the limiting principle that says 45% is OK but 95% is not ?

You feel driven to extremes – because you can’t find one, because there isn’t one. The size of government is already far past any optimum and more is just increasing worse.

That is just one issue but they are all the same.

Whatever the issue, if you want to stake out some middle ground – why ? What distinguishes your “moderate” compromise position from some other position ?
Why aren’t either conservatives or liberals actually right ?

There are occasionally reasons for compromise, for settling for less.
But being willing to compromise even valuing compromise does not make the compromise position more right than either extremes. Often it is worse than either extreme.

You also feel forced into extreme positions because you have chosen a subjective value system. Trying to structure a value system arround “fairness” is begging to be thrashed. It is trivial to turn fairness on its head. Not only is it subjective, but it is self contradictory – trying to be fair to one group or value inevitably is unfair to another. So long as you claim some permutation of fairness as a value, it will be trivial to turn you around and tie you in knots. One of the most critical failings of progressivism, is that it can not possibly deliver what it promises to everyone, it can not even deliver some of what it promises to some people. Combining fairness and progressive values offers limitless avenues of attack.

The failures of progressive values and fairness are not your failures, but so long as you chose to own them, you are stuck defending them.

Essentially you are the victim of the classical liberal version of Alinsky’s “Rules for Radical’s”. Most of the arguments I make are a couple of hundred years old, They have been well tested. What is more remarkable is that progressive values which have been proven false both by logic and history still have a faith based following.

Lets compare healthcare to something that actually is a right – the freedom to have whatever religious beliefs one chooses.

If our spiritual health is so important – why should we leave individuals free to chose their own path ? The penalty for holding the wrong beliefs at least in some systems is eternal damnation. Surely the precautionary principle would suggest that regardless of what we truly believe we should adhere to one of those systems – after all why risk eternal damnation when the risk can be diminished by a defensive choice of religion ?

I should think eternal damnation would be a far worse outcome than getting sick without health insurance. A majority of us should get together and determine which religion we should all believe in – after all it would be in everyone’s best interest.

And we should compel atheists to believe in something no matter what – if you don’t believe in anything then you are facing some form of eternal damnation from nearly every religion in existence – by forcing everyone into one religion – even those who do not want to believe in anything we significantly increase they odds that none of us will face damnation in the hereafter.

What about your choice of spouse – or your choice not to have a spouse ?
This is a freedom that did not exist in other eras, that we take for granted today.
A bad choice can have catastrophic consequences.

Yet we allow ordinary people, people who on the whole clearly make poor choices to chose their own spouse. There is no government mandated spouse.

Nor do we all get equal spouses. Some of us strike out in the mating game, some of us are fortunate enough to find soul mates.

Shouldn’t we all have the right to the prefect spouse ?
Shouldn’t we do something about spousal inequality ?

What about the right to work – that is a right isn’t it ?
Some of us get better jobs than others, shouldn’t we redistribute jobs more fairly ?
Some of us – possibly even through little of no fault of our own end up with no job.
Mustn’t government do something about this ?

Instead of finding our own way to a job, or career of our own choice – and that is what free market means – the right no make our own choices, nor is it just about which brand of coffee to by, it includes the freedom to chose what to invest our soul, our very being into.
Anyway why not just let government assign us all a job based on our skills. Everyone can get equal pay, and jobs will be divied up based on what each of us is best suited to.
wouldn’t the world work better if those best suited to any task where those given that task ? And everyone would be employed 0 full employment is actually extremely easy to achieve. Government could put all the unemployed to work tomorrow. The WPA quite successfully employed millions during the depression – of course it cost almost 7% of GDP, and produced nothing close to that in value.

Or as Keynes suggested if we want full employment we can give everyone spoons and set them out to dig holes and fill them up again.

But our wealth as a nation and as individuals is rooted in what we produce not how hard we work.Full employment could easily be achieved by returning the nation to subsistence farming – though we would all live in poverty.

Producing is what we are obligated to do (though often with enjoyment), in order to consume. It is not a right, it is something we must do for ourselves. Nor is it fair. We are each differently talented. What is easy for some is hard for others.
Nor are we all so fortunate that what we love to do and what we are good at are the same.
Sometimes we must do jobs we hate in order to get other things that we love.
Some of us take risks – both big and small, and frequently fail. But it is from those occasionally successful risks that the value is produced that increases not only our own wealth but that of others.

Nice try, Dave, but I could extend your reasoning to other areas of life and you’d see (I think) how your argument might fall apart.

You’re in favor of free choice and limited government, are you? Great. Then I guess you’d agree that we shouldn’t be using our tax money to pay for highways and bridges. Let drivers take their own risks when they venture out of town… let them decide for themselves if that 60-year-old bridge is sturdy enough to cross. If the car plunges into the river… hey, they knew the potential dangers and they made the wrong choice.

Walking on a city street with a wallet full of cash? A sinister figure approaches you from behind. Do you really expect the government to hire police to protect you? C’mon, you made a choice to leave your home without packing a pistol. You knew the risks.

Same with military invasions by hostile powers. Each citizen should be aware that our foreign policy might incur the wrath of our enemies, so they must prepare to defend their own homes against artillery fire and nuclear warheads. They knew the risks of living in America; if they didn’t want to be attacked, they could have moved to Switzerland. (It’s prettier and the chocolate is first-rate.)

You get the idea. There’s a line of demarcation somewhere between personal responsibility and government obligation. We just don’t agree about where that line should fall. I think it should fall somewhere in the middle. That’s why I call this blog “The New Moderate” and not “The New Libertarian” or “The New Socialist.”

Most of the “infrastructure” things you think of as public, have only been so more recently.
The Brooklyn Bridge was one of the fast “Public/Private partnerships” Mostly because the acquiescence of Tammany hall was necessary to complete it and Boss Tweed had to reward his troops – otherwise it would have been entirely a private project. All major bridges prior had been.
Most of the 19th Century Canal system was built privately. Until the 20th century most roads were constructed privately, The hoover Dam started privately. Most of this country was electrified privately until Government took private companies over or forced them out of business, Our Bus system was private in most areas into the 1960’s. Our trains started privately and almost all rail lines are private.

As to safety, despite the fact that government now owns all the infrastructure and we spend way too much on it, we still have myriads of failures spectacular and mundane. I am atleast as reluctant to trust a government engineer with permanent job security, and no liability than a private company that will pay a steep price should their failure result in my harm or death.

In everything I have ever written here – when have i claimed that government is not responsible to protect us from the violence of our fellow man ? That is the root of the social contract it is governments sole reason for existence. It is the one task that most of us cede that only government can do. Though still it does it badly.

It is unimportant whether the source of violence is the mugger on the street or a foreign invader.

Jefferson put it better than I can

[all men] are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.–That to secure these rights, Governments are instituted among Men.

Government acting to secure our rights – rather than limit them, is the legitimate role of government – nothing else.

Government is only distinguishable from voluntary private association in that government is solely entitled to the right to initiate violence.

Nothing else distinguishes it from a church, a union or a corporation.

Any problem that you see that does not require that power is inarguably as well served privately.

It specifically that priviledge to use force that requires government to be as limited as possible.

Most of us deplore violence – we resort to it only in self defense.
When we decide that government is necessary for some function, we are deciding that that function can not be accomplished voluntarily, that it can only be accomplished by ceding liberty – by force if necessary.

Protection from others using violence to diminish our rights, is the only legitimate use of force, the only legitimate role of government, and the only arena in which it is actually arguable that government is better able to do the job – because it is only that privileged to initiate force that distinguishes government from any other voluntary association we may form.

Government has only one obligation – to protect us from the violence of others.
If you wish to propose and debate others – go ahead.

Even using your muddy logic – somethings are real rights, and should only be infringed upon for the most compelling reasons. Other things are clearly not rights, they are wants, or needs.

Most of us would like to diminish need are want. That desire does not create an obligation that government accomplish that.

Even accepting that there might be some benefit to government assisting in meeting a need or want, that effort can not come at the expense of real rights.

If you have no ability or no desire to distinguish between those few things that a real rights and the myriads of things that are needs and wants, then moderate means nothing beyond the tyranny of the majority.

Clarity in thinking and language matters. Ian apparently believes that having values and priorities automatically makes one extremist.

Moderate as defined here eschews concepts like rights, values seeing everything only as needs and wants. By ignoring rights and values, any argument for anything can be made to make sense.

Though fairness is infinitely maleable, because it is a derived rather than core value, all your claims about fairness are ultimately rooted in rights, and freedoms.

Blacks, Gays, Women are entitled to fair treatment because they have exactly the same rights and freedoms as everyone else. If you ignore rights and freedoms – fairness is nothing but whim.

If fairness does not derive from rights and freedom – then it has no meaning.
If it does then you are forced to distinguish rights and freedoms from needs and wants and weigh them accordingly.

“To each according to their need from each according to their ability”, is a noble sentiment. It is also the core of communism not moderation.

Rick, I don’t think it is unreasonable for moderates to be concerned with the intrusion of government into personal responsibility. Your arguments about infrastructure, military and crime prevention don’t make sense to me, because no one has disputed that these fall within the category of legitimate government obligation. Healthcare, not so much.

Yet, by moving in the direction of making health care a “right,” thereby justifying government control over the system, you are clearly moving in the direction of the kind of nanny-state intrusion and power over the individual that I have seen you argue eloquently against. Once the goverment controls healthcare dollars and must ration care, it becomes completely logical to withhold care from those who have made personal choices that the government could construe as “bringing it on themselves:” smoking, drinking, not exercising, eating fatty foods, etc.

“You have lung cancer, and it says here that you smoked for 20 years. Unfortunately, we have limited resources for cancer treatment, and they must be spent on those who have not made unhealthy and dangerous choices, which may have led to their disease. We’re sorry, but we can offer you hospice care when the pain becomes too great.”

You trust in the goodness of government, so you probably think that I am stretching too far, here. But this is not unlike what is already happening in the UK.

While ultimately we may get to punishing smokers, the obese, soda drinkers…. that may take time.
But infringement on liberty must start immediately
There is no means by which government can reduce the cost of healthcare but by saying “no you can not have what you want”. It does not matter whether they are telling a 79 year old they can not have knee replacement, an 80 year old that they can not have chemotherapy, or a doctor or hospital that they can not set their price for their services.

Controlling costs requires imposing constraints. The only question is whether those constraints will be imposed by rigid rules decided by our betters in Washington, or whether they will be self imposed and flexible depending on our individual resources and values at the moment.

asmith, you bring up an excellent point about where constraints are created. One of the issues with the high cost of healthcare today is the end of life spending for Medicare patients. Most of the cost for medicare comes in the last few week of life and that is due to extraordinary means that people expect doctors to administer to the dying. Is it reasonable to provide services that cost $100K-$200K on a patient when the doctor has told the family that their father or mother will not live more than a week to a couple weeks? I know this may sound cruel and may sound like rationing of care, but reasonable people have to make reasonable choices. When my dad had his cerebrial hemmorage many years ago, the doctor told us he would not take any extraordinary means to keep him alive as there was little chance he would survive. That is a decision many are not making today and it is one of the many reasons healthcare costs for seniors is increasing so drasticlly.

You know, the policy makers obsess over the use of healthcare services yet the US is among the lowest users of MD and Inpatient services of all the OECD countries. In fact, 74% of the nominal increase in HC costs in the US over the past 31 years is from unit price inflation. Services delivered in some cases creates an issue but by far, the area (totally ignored by policy wonks) is price inflation.

RonP, I agree that end of life care has become a cost containment issue. But, I worry that, in order to ration increasingly limited resources, the bar for what is considered end-of-life will be increasingly lowered, and begin to impact healthy and relatively healthy old people, who will be denied care on the basis of age. And, given that Medicare coverage decisions will be made by a panel of 15 unaccountable bureaucrats – the IPAB – who will have sole decision making authority over reimbursements. Maybe not exactly “death panels,” but, if dying inexpensively is a priority, it’s not hard to see where that will lead.

At the current rate, it will not matter who is making reimbursement decisions since in just a few years (10-15 years), 100% of all federal income tax revenues will go to pay for healthcare reimbursement for Medicare and Medicaid patients unless something huge changes that trend. That means that everything else will be borrowed money including the interest on the national debt. And we all know what happens with family budgtes when they have to borrow money to pay even the interest on credit cards. They go bankrupt in a few short months.

Does anyone think the majority of politicians in Washington really understand this problem?

“Rationing” is not just inevitable, it is the norm for everything. We can not have all of everything that we want.

The question is how do we ration ?
The only successful system that we have is the market.
goods and services are priced based on our individual values and preferences and then we chose based on those preferences and our available resources.

I could care less if some “evil rich person” wastes $500K trying to prolong the last few days of their life. At the same time the rest of us may well benefit, what works becomes cheaper and eventually available to all of us.

The only question is who is going to decide ?
When government decides it is called price controls and if inevitably fails.

The freedom to choose is extremely important. It includes both the freedom to waste huge amounts of money futilely – so long as it is our money, and the freedom not to do so. It is the choices we make that inform the rest of the market where to direct resources.

Do we value a few more weeks of life more than vacations, fancy houses, time with our children, dinners out, ….. ?
Wherever we chose to spend money that is what we will get more of.
And getting more of those things we value most sounds like the best outcome to me.

asmith..you stated something to the effect that you could care less if some rich person spends 500K in the last few days of life on healthcare costs. If this were someone under 65, then that could be an acceptible arguement to make since it is only impacting one person or family. However, as our medicare laws are written, it is illegal for any provider to accept any payments from patients other than deductibles and co-insurance amounts on those bills. If you are Warren Buffett and want to pay all of your healthcare bill, the provider accepting that payment is guilty of voilating the Medicare laws. So if he spends 500K on his life to prolong it for another couple week, the cost is paid for by the government, which now is going to be paid for by future generations as we have already spent the money we paid in years ago on other patients due to incompetent government management of the Medicare system.

Medicare Part B is optional and one does not have to take it (or pay for it). Part A is free and you have it if you are eligible. However, you do NOT have to submit claims to Medicare if you do not want to (in other words, you can direct pay for your own care.

jbastiat..You are correct about Part B being optional and the patient paying the physician bills and the outpatienbt services. but in this example of 500K over a months time period or so during the last days of life, one has to assume that would be inpatient services with all extraordinary means being taken to keep the person alive. In this case, the patient can not decline part A services, the premiums are deducted from their SS benefit checks and the hospital can not bill the patient other than for deductibles and co-insurance.

It is the same with medicaid also. Nothing else can be billed to a Medicaid patient for either I/P or O/P services.

I don’t believe you are correct (but am not certain). I believe that a patient is free to waive medicare coverage for any service they want and to directly pay for it if that is their desire. I will check with my collegue who teaches law but it is my understanding there is no limitation here whatever.

There are no premiums for part A but as of now, the patient cannot opt out of part A, in other words you have it or if you opt out, you also lose your SS benefits. Now, if you are very rich, you can certainly do that also and the Feds can’t do anything about it.

What is not clear is whether the patient is free to pay out of pocket for a covered service (in other words, can they instruct the hospital to bill them directly for a covered service).

You seem to be incredibly knowledgeable on healthcare issues, and with very few exceptions you appear to be right about almost all of them.

The primary places we part company is you do not seem to grasp that the root cause of almost all the healthcare problems are the unintended consequences of government policies, and that so long as we chose an imposed top down solution we will continue to have myriads of unintended consequences.

You and i can speculate about what aspects of PPACA will succeed and which will fail, and how. Our guesses might even be good. but ultimately that will be decided in “the marketplace”. What can be reasonably well established is that there will be uninitended consequences. That no matter what rules government imposes doctors, hospitals and insurance companies will work hard to find ways to benefit from them.
Progressives, TNM’rs and our current president would call that greed or other vile names, but it is just normal self interest.

Of course Dr’s will close the office rather than see patients and lose money.
Ultimately if they can not succeed as they wish they may leave medicine.
We will either end up with fewer doctors, or worse doctors.
Or some other negative result.

It is not necessary to accurately predict how PPACA will fail. It is sufficient to know that it is not possible for government to impose rules that can not be gamed.

Another issue that you and most here do not grasp is that decisions are made on the margins. As an example governments arround the world have successfully coerced drug manufacturers into lower prices – and drug companies have not withdrawn from those markets. This can continue so long as those companies can continue to pay their core costs from profits in the US. The cost of selling more of a drug whose development costs will be paid in the US market, is only the manufacturing cost of that drug. It can be sold profitably at small margins. But if you take away the US market and its high drug prices that cover development costs, the prices in Canada and elsewhere are unsustainable.

The US Healthcare market pays for the vast majority of the development costs of almost all modern medicine. Our idiotic regulations often see our developments appear elsewhere in the world first, but it is still the US market that will cover the development costs. The costs for most of the rest of the world are only marginal costs. So long as the US market covers development costs, the rest of the world will have cheaper medical costs.

Marginal costs apply equally well to doctors offices and medicare.
Today private patients pay the core costs of US healthcare. But the ratio between private and publicly funded patients has been slowly shifting. This has driven up the costs of private patients (and insurance) but that can not continue forever. Eventually private patients will be unwilling to pay – that is how markets work.

More and more doctors, pharmacies, clinics and other aspects of healthcare have been shifting towards cheap private pay services.

I can go to my grocery store for an increasing amount of routine medical care at reasonable prices – but I pay out of pocket and getting re-imbursed by insurance is my problem – because the administrative costs and the time value of money associated with even private insurance much less medicare and medicaid is enormous.

To a doctor a walk in patient paying cash costs him only his time.
While a medicare or insurance patient has carrying costs for the time it takes to get paid, plus enormous administrative costs dealing with insurance and medicare.

To your point about doctors closing offices rather than lose money (greedy bastards!), Dave – that concern is already rampant in the medical community. But perhaps just as great is the fear that the mandated benefits of ObamaCare will create an overwhelming demand on the system, flooding doctors’ offices, and making access significantly more difficult everyone…and when the system is flooded, it is very likely that the elderly and disabled will suffer the most.

A while back, I read that, if every Medicare patient took advantage of the free annual checkup, we would need 25,000 new doctors just to meet that basic demand. And this is now, before the expanded “free” benefits of Obamacare hit. It is pretty much widely agreed that Obamacare will not exactly swell the ranks of physicians – just the opposite. My own dermatologist told me that he is waiting until after the election, and will be retiring early if Obamacare is not repealed. He says he is not comfortable with the idea of patients having to be booked on 5 mnute intervals, waiting months for procedures, and other types of care rationing that would likely have to occur, and, since he was going to retire in 6-7 years anyway, he’ll just go early (and this guy voted for Obama in 08). I’m sure he is not the only one.

Relative to other developed OECD nations, the US is relatively “under-doctored.” In large measure, this has been engineered by the AMA, which has undue influence on the accreditation of medical schools in the US and in federal funding for medical education. They have also restricted the number of residency slots for FMG’s, so we do not bring in as many MDs as would like to practice here.

While we have added some aggregate capacity to produce MDs, we still lag other nations in that regard.

It is not important whether my specific predictions – or yours come about.

It is absolutely certain that PPACA will have unanticipated effects beyond those intended.
All actions do.
But two things are different in the free market:

The impacts are smaller because actions are smaller. hundreds of millions of people only act in exactly the same way when propelled by government.
See Housing Bubble (and Education Bubble, and pretty much all other Bubbles).

When the consequences are not as anticipated individuals alter their behavior immediately. If PPACA works differently than expected, it could take years for government to make adjustments.

One thing that you noted is that PPACA could fail simply by succeeding.
Completely unaddressed by PPACA, is how are the additional benefits it confers going to be provided.

There is an assumption that the uninsured are already getting sufficient medical care. If that is true (and it is ) why did we need PPACA ?
If it is not – or if PPACA increases the demand for medical care from the previously uninsured there will not be sufficient resources to provide that care.

In the marketplace when demand exceeds supply prices rise often dramatically until supply catches up or until demand decreases.

When you fix the cost regardless of demand then you end up with shortages, grey markets, suppliers leaving. It is the increase in cost that drives the increase in supply needed to meet the demand. Prevent one and you prevent the other. Unless we are really going to turn ones choice of job over to government, we will not get more medical care personel absent a change in the reasons that people chose those professions – such as higher pay. Eliminate the incentive and even though demand skyrockets, supply remains the same or declines as trying to serve far too many people becomes less and less rewarding.

It it irrelevant whether my specific predictions come about.

What is certain is that when you use and external force to shove the marketplace in a desired direction you distort the market, foul up all the signals, and you end up with results far different than you anticipated.

For those who think the governments creation of infrastructure is so important – how are you going to build that bridge absent the tools and supplies that all come from the market. Everything that all of us do – even government has hundreds of layers of dependence on things that come ONLY from the marketplace.

The AMA’s ability to limit the number of doctors, is dependent on government. There are no historically sustainable cartels that do not depend on government.

All licensing – and we are far past just licensing professionals is a bald faced attempt to drive up wages and profits by limited supply.
Most regulations – even when they did not start as such either are deliberately turned into barriers to entry by the regulated industry or they become barriers to entry on their own.

One of the stupidest memes of the left is that they are at war with big business. Greedy CEO’s pour far more money into the coffers of pro regulation legislators, Big business is far more afraid of marketplace competition than government. Big Business attempts to shape regulation – they want barriers to entry not burdens on established business.

You are correct, but I would remove the word “greedy” from the statement. What is going on is as natural a rain. One is naturally inclined to improve one’s position. However, since the government is supposed to work for the citizen’s of this country, it should be priority one that they keep markets open. That means saying NO!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

No more worries. The Fed will announce QEIII today. Open-ended purchase of $40B bonds per month until ”morale improves” (or Obama wins the election, whichever comes first). If only Bernanke had explained to us from the start that running up unimaginable public debt and inflating the currency was the way out of this, things would have been so much better!

Someone earlier was complaining that no one was able to make any money on their investments, CD, savings accounts.

Arguably the Fed’s purchase of government bonds has little or nothing to do with the real economy. It is primarily an effort to keep the price of government debt low. Small increases in the interest rates on our debt could be disastrous and snowball rapidly.
It is little more than an admission that real risk for US debt is much higher than reflected in the distorted market.

At the same time so long as the interest on Treasury bonds remains artifically low, returns on everything else will remain low too, and absent a decent return no one will invest and the economy will not grow.

Worse because the downward preasure is artifical not real, it can not be sustained indefinitely. We essentially have created another bubble – but this time a bubble of artifically low prices. Any artificial price bubble must eventually burst.

I can speculate about the effects, but it really does not matter whether I am right or not, the effects will certainly be atleast as large as the cause, and negative.

The Federal reserve has greater ability to force and sustain a bubble than any other institution on earth. The combined central banks of the world probably do not have the wherewithall to go toe to toe with the Fed and know it. But this just means the bubble will last longer and grow even larger, and have even more devastating consequences when it bursts.

I have to admit economics is not one of my strong points, especially when there are as many economist supporting an action as criticizing an action. Yes interest rates are low, but there are low entry investment funds where one can gain a 4-5% return. One just needs to do some research to find them and in this day and age, they are almost as secure as our government debt given that is no better than money in a can buried in the back yard.

one of the reasons that the US Government (or any government) credit rating matters, is that any entity within that nation whose finances rest on the nations money (pretty much all business), can not possibly have beeter credit than that of the nation itself.

Put differently if the dollar became worthless what business in the US would be solvent ?

interest is a price just like any other price. It is driver by the laws of supply and demand. Interest is the price of time preference for money.

You are willing to part with money now, in return for more later – that difference is interest, and it is the price for my wanting money now rather than later. Additionally interest has a risk price – I give you my guaranteed real money now, in return for not so guaranteed more later. Because is some risk I will want a higher premium – the price – the interest rate rises.

The Federal Reserve is supposed to manage the money supply to stabilize interest rates and growth.

Economist disagree on precisely how to do that. Further since 1977 Maximizing employment was added to the Federal reserves mandate.

Regardless, the generally agreed principles are that low interest rates spur growth (People can borrow more cheaply to create things, and people with money are actively seeking a higher return than they can get by saving)

. But too low interest rates result in un-naturally high, false growth or bubbles – take your pick of descriptions. Further interest rates that are too low cause risk to be mispriced – I have heard credible claims that a 5! increase in the mortgage rates for sub prime mortgages would likely have prevented the housing bubble. The effects would have been two fold, it would have reduced the number of sub prime mortgages, and it would have made them sufficiently profitable to cover the risk.

The reason interest rates for greek, Spanish and Italian Bonds are high is because the risk is high. Interest is a price and risk is a part of that price.

So QEIII or IV or whatever it is, involves purchasing more treasury bonds.
Since that is an increase in demand it means an increase in price – and for treasuries that means a decrease in the interest rates.
That should be good. The problem is that it is an artificial decrease.

Interest rates too low for too long is a pretty much accepted major factor if not primary cause of the housing bubble and our current mess.

So if driving housing prices down caused the housing bubble and eventual collapse, the financial crisis and our current economic mess,
What is going to be the effect of driving treasury interest rates artificially low for too long ?

I do not know precisely – but it is not going to be good.
As mentioned the US is a special case. As the entire world economy depends on ours, markets are not going to react to our idiocy as quickly or exactly the same as say Greece. Sorros became very wealthy by grasping that the Bank of England had mispriced the pound.
But how do you profit by betting that the entire economic system is going to collapse – which is essentially what a bet on a real US default is. Even if you win you lose.
While that may sound good, it is actually bad. It means we will be allowed to get much closer to catastrophic disaster than say Greece would be.

some interesting things to note would be:

Interest rates are unbelievably low at the moment – why don’t we have incredible growth ? There is really only one reason – the risks are too high even at low interest. The risks are too high because government regulation in various forms has increased the cost of business. They are too high because the people with money are told repeatedly by the president and most of the people on this blog that if they manage to make money they are not going to be allowed to keep much of it.

Ultimately even with the economic idiocy coming from our white house, this log jam will break. Someone will figure ways arround the new rules, or ways of profiting that government has not yet destroyed.
And then the left will start railing about greedy businessmen writing loopholes for themselves, and not placing the interests of the country first.
There were several nascent recoveries during the Great depression that FDR squashed with new rules, new regulations new taxes, and contradictory policies.

I do not know what the consequences of this or past Federal Reserve actions are, only that they are unlikely to be good.

The amount of money the Fed has dumped into the economy since this began is beyond belief. An awful lot of economists are deeply concerned because there has been little inflation and little growth. We have actually exported some inflation – rising food prices in the Mideast are a major factor driving the Arab spring and what you are seeing now. They do not hate us so much because their religion is intolerant or because someone made a movie insulating mohammed, but because bread prices have skyrocketed.

Still within the US, huge increases in the money supply, no significant inflation, and no growth. Essentially the entrepeurial class is one strike. Atlas Shrugged is really playing out in front of us.

The enormous scale of shadow money in comparision to paper money is a factor. In the modern world government money – is a much smaller part of the economy than 100 years ago. Even the federal reserves is dwarfed by stock exchange trading – and stocks are another form of money.

Dave, I wish I could believe the trollish Krugman. But I believe that the Fed is simply out of control, and has been pushed into this new folly by the administration, which is willing to sacrifice long term economic health for a few weeks of stock market gains and easy money. Even Bernanke has repeatedly said that monetary policy is not the key to jumpstarting this economy, and if it’s not, and if it carries an extreme risk of starting an inflationary spiral that will be very difficult to stop, then why do it, other than for political reasons?

For those who believe that this easing will “work” I would simply say: Yes, and Santa Claus is real. More importantly, it will be VERY PAINFUL to unwind, eventually. I can even see a scenario where the Federal Reserve declares bankruptcy. Of course, the US Treasury will have to recapitalize it, with well, more printed money.

I am not trying to sell it – frankly it scares the hell out of me, but thus far it is done little obvious harm. We have not overheated the economy, in fact measures that should have thrown it in to overdrive and risk huge new bubbles and inflation have left it somehow still stalled – we should seriously think what that might mean.

Inflation is still low, US debt costs are incredibly low.

There are really very few possible explanations:

Paul Krugman is right and we have not dished out a fraction of the stimulus actually needed – though we have pretty much proved fiscal stimulus does not work, Trying to conceive of what greater monetary stimulus might be is itself mind boggling, the Fed has already had to get extremely creative to inject money into the economy.

An enormous amount of fiscal/monetary force is building up behind the economic log jam and the dam is eventually going to burst – and that is likely to be far worse than the good news it sounds like.

There are really good fundimental reasons that stimulus can not overcome – or even is making worse that the economy is not moving forward.

The 2nd and third reasons are not actually mutually exclusive. Actually all of them could be true to some extent.

2). The Fed is now apparently committed to monetary stimulus through 2015 – even if the economy recovers.

Inflation is a monetary phenomenon. There is absolutely no such thing as free market inflation. Inflation is what happens when money supply grows faster than what we produce.

We have not had significant inflation as a result of the Feds Machinations todate, because even though the quanitity of money has increased dramatically the velocity of money has tanked and is still in the tank. Real money supply is quantity times velocity.

Numerous libertarians have been predicting significant inflation as a result of the fed games – so far they have been wrong.

But no sane economists believes the Fed can leave all the money they have dumped into the economy in place as recovery starts. One of the trickiest tasks the Fed has in the future is going to be removing money fast enough to avoid significant inflation and slow enough not to kill the economy.

The good news is we know exactly how to kill off serious inflation.
The bad news is that it requires deliberately causing a recession.

Our best hope for the future may well be that the Fed fails with QEIII.
The price of succeeding could be really bad.

A good introduction to economic is Henry Hazlitt’s economics in one lesson.
It is fairly easy to read. Covers most of economics and is free.
It is fundimentally an expansion of Bastiat’s works – which are also an excellent introduction to economics while being actually fun to read.

If you want even simpler try
FUNDANOMICS: The Free Market, Simplified
It is a fun easy read, but it is not available for free.

If you want something by a major modern economist that is also pretty easy to read
try First Principles: Five Keys to Restoring America’s Prosperity by John B. Taylor.
But this is more an examiniation of our current problems from the perspection of key principles, than a basic explanation of economics.

Hayek’s Road to Serfdom – predicts our current mess from just after WWII,
Ultimately it covers most significant aspects of economics though the book is more about the failure of central planning, and despite language that is not difficult, the thought is so deep that you have to reread every paragraph multiple times to comprehend it.
It is sort of like Lord of the rings on steriods.